Bone tuberculosis: a case report on child

Clinical-Morphological Aspects in Spinal Tuberculosis

Osteoarticular tuberculosis (OATB) Aim: The authors made a clinical morphological assessment of tissue samples from patients admitted in Surgical Departments of the Emergency County Hospital of Craiova, Romania, between 1990 and 2015, proved as presenting tuberculous lesions of the spine in the Department of Pathology of the same Hospital. Materials and Methods: The studied material consisted of bone, joint and sometimes muscle tissue fragments resulted from biopsies or surgical excisions from 7 cases coming out of 54 patients investigated in the above-mentioned period of time, where the established histological diagnosis was tuberculosis (TB). For diagnostic confirmation, Ziehl-Neelsen staining has been used as a rule but, in some cases, immunohistochemistry was also used. Results: TB lesions have prevailed in men and around the age of 50 years. Thoracic segment of the spine was the most involved. Epithelioid and giant Langhans cells dominated the inflammatory cellular population. Necrosis was always present, usually in its classical acidophilic form. Fibrosis was almost always absent. On the whole, the granulomatous reaction was in almost half of the cases hyporeactive and disorganized. Conclusions: The clinical morphological profile of our series is fitting with data described in the literature. Because of its life threatening potential, spinal TB should be investigated thoroughly especially in its morphological features in order to obtain as quickly as possible an etiological diagnosis.

Coexistence of a Ghon Complex, Pott's Disease, and Hip Arthritis in a Child

Introduction

Tuberculosis remains a major public health problem in developing countries. Diagnosing extrapulmonary tuberculosis can be difficult, as it requires a higher index of suspicion than primary tuberculosis. Extrapulmonary tuberculosis may mimic malignancies and many other diseases, so it should be included in the differential diagnosis. Here, we present a case of extrapulmonary tuberculosis associated with Pott’s disease and hip arthritis in a patient who recovered after 12 months of antituberculosis therapy.

Case Presentation

A 16-year-old girl presented to the outpatient otolaryngology clinic with painless swelling of the neck, and to the physical medicine and rehabilitation clinic with complaints of hip and low back pain that mimicked spondyloarthropathy. She was eventually referred to the outpatient pediatric clinic. Her acute-phase reactants were high, and hilar lymphadenopathy was evident on chest x-ray. On computerized tomography, a Pott’s abscess involving the T8, T9, and T10 vertebrae was suspected. Magnetic resonance imaging of the dorsal vertebrae and hip was performed, and a Pott’s abscess and hip tuberculous arthritis were confirmed. The patient had been exposed to tuberculosis 10 years earlier, and her purified protein derivative (PPD) test was 16 mm. After antituberculosis treatment, our patient recovered and the Pott’s disease and hip tuberculous arthritis regressed.

Conclusions

Extrapulmonary tuberculosis may mimic many other diseases, so it should be kept in mind in the differential diagnosis. It is essential to diagnose osteoarticular tuberculosis early, as late diagnosis or inadequate treatment may cause permanent disability.

Clinical peculiarities of tuberculosis

The ongoing spread of tuberculosis (TB) in poor resource countries and the recently increasing incidence in high resource countries lead to the need of updated knowledge for clinicians, particularly for pediatricians. The purpose of this article is to provide an overview on the most important peculiarities of TB in children. Children are less contagious than adults, but the risk of progression to active disease is higher in infants and children as compared to the subsequent ages. Diagnosis of TB in children is more difficult than in adults, because few signs are associated with primary infection, interferon-gamma release assays and tuberculin skin test are less reliable in younger children, M. tuberculosis is more rarely detected in gastric aspirates than in smears in adults and radiological findings are often not specific. Treatment of latent TB is always necessary in young children, whereas it is recommended in older children, as well as in adults, only in particular conditions. Antimycobacterial drugs are generally better tolerated in children as compared to adults, but off-label use of second-line antimycobacterial drugs is increasing, because of spreading of multidrug resistant TB worldwide. Given that TB is a disease which often involves more than one member in a family, a closer collaboration is needed between pediatricians and clinicians who take care of adults.