Musculoskeletal Tuberculosis: New Insights on Diagnosis Strategy and Treatment.

BACKGROUND/ OBJECTIVE: Skeletal tuberculosis (TB) is rare. We aimed to report on diagnostic strategy and treatment of skeletal TB. METHODS: In this multidisciplinary single-center medical records review study, all adult patients admitted between January 2009 and December 2019 with microbiologically proven skeletal TB were included. Demographic, medical history, laboratory, imaging, pathologic findings, treatment, and follow-up data were extracted from medical records. RESULTS: Among 184 patients identified with TB, 21 (16 women, 42 years [27, 48 years]) had skeletal involvement. Skeletal TB included spondylitis (n = 11), lytic bone lesions (n = 7), sacroiliitis (n = 5), arthritis (n = 3), osteitis (n = 2), and diffuse muscle abscesses without bone lesion (n = 1). Lytic lesions involved both axial and peripheral skeleton at multiple sites in most cases. 18F-fluorodeoxyglucose positron emission tomography was performed in 13 patients and helped to detect multifocal asymptomatic lesions and to target biopsy. All patients were treated with anti-TB therapy for 7 to 18 months. Fifteen patients (71.4%) received steroids as an adjunct therapy. Eleven patients needed an orthopedic immobilization corset, and 3 patients underwent surgery. All patients clinically improved under treatment, but 2 relapsed over a median follow-up of 24 months (12-30 months). No patient died or suffered long-term disabilities. CONCLUSION: Our study emphasizes the diversity of skeletal involvement in TB. 18F-fluorodeoxyglucose positron emission tomography scanner at diagnosis is key to assess the extension of skeletal involvement and guide extraskeletal biopsy. Neurological complications might be prevented by adding corticosteroids to anti-TB therapy.

Diffuse spine involvement in sarcoidosis with sternal lytic lesions: two case reports.

STUDY DESIGN: Case report. OBJECTIVE: To report 2 cases of sarcoidosis with a diffuse vertebral involvement, associated with a rare location in the sternum. SUMMARY OF BACKGROUND DATA: Sarcoidosis is a systemic disease of unknown cause with various clinical and radiologic manifestations. Bone involvement is rare (1%-13% of cases). Vertebral involvement is very uncommon. Lytic lesions, sclerotic lesions, or both of these patterns may be observed. METHODS: One patient complained of diffuse bone pain; the second patient was asymptomatic. Each patient had radiograph, CT, and MRI of the spine. The second patient also underwent a PET/CT FDG-(18F). Sternal bone biopsy was performed in both patients. Pathologic findings indicated typical pattern of bone sarcoidosis. Clinical and biologic improvement was noticed after treatment with corticosteroids. RESULTS: In our 2 cases, radiograph, CT, MRI, and PET/CT findings were evocative of diffuse spine involvement in sarcoidosis associated with sternal lytic lesions. This suspicion was confirmed by histopathologic findings, which found a typical pattern of sarcoidosis. CONCLUSION: These 2 cases emphasize the value of CT, MRI, and FDG-(18F) PET/CT for the diagnosis of diffuse spinal involvement in sarcoidosis and describe an exceptional association with sternal lytic lesions.