RESUMO
BACKGROUND Multifocal tuberculosis (TB) with more than 1 tuberculous osteoarticular lesion is rare. Furthermore, metastatic tuberculous abscess (MTA) is also a very rare manifestation of cutaneous TB in children. A non-specific, often subtle, early clinical presentation in conjunction with a low prevalence rate constitute obstacles for diagnosis. CASE REPORT A 9-years old female patient was referred to Hasan Sadikin Pediatric Respirology Outpatient clinic from the Orthopedic Department with lumps at the left elbow joint, lateral side of the left hand, and lateral side of the left foot. Fine needle aspiration biopsy of the lumps suggested a chronic inflammation due to TB. The patient was then started with a course of anti-TB drugs consisting of rifampicin, isoniazid, pyrazinamide, and ethambutol. During the treatment course, she experienced anti-TB drug-induced hepatotoxicity (ADIH). We then switched the regimen to streptomycin and ethambutol for 2 weeks, then reintroduced treatment with the modified British Thoracic Society guidelines regimen. The nodules appeared shrunken after 3 months of treatment with anti-TB drugs. CONCLUSIONS Increased awareness of unusual manifestations of TB will likely allow for proper diagnosis and management of this common infection. Accordingly, timely diagnosis and management will prevent further debilitating sequelae.
Assuntos
Abscesso/microbiologia , Osteomielite/microbiologia , Tuberculose Osteoarticular/diagnóstico , Criança , Feminino , Humanos , Ossos Metacarpais/diagnóstico por imagem , Ossos Metacarpais/microbiologia , Radiografia , Tuberculose Pulmonar/diagnóstico por imagem , Ulna/diagnóstico por imagem , Ulna/microbiologiaAssuntos
Ossos Metacarpais/microbiologia , Osteomielite/microbiologia , Polegar , Tuberculose Osteoarticular/diagnóstico por imagem , Antituberculosos/uso terapêutico , Criança , Terapia Combinada , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Ossos Metacarpais/diagnóstico por imagem , Osteomielite/diagnóstico por imagem , Osteomielite/terapia , Tuberculose Osteoarticular/terapiaRESUMO
Primary tuberculosis osteomyelitis of metacarpal bone is rare. The majority of cases occur in children and young adults and there is difficulty in diagnosis mainly in young children. We report a new case in children aged of 3 years, presenting a swelling on the dorsal side of her right hand since 8 months. X-ray showed an expansile, cystic and lytic lesion involving the little finger metacarpal. Tuberculosis was confirmed on histological examination. No lesions in lung parenchyma or lymphadenopathy were associated. Patient was successfully managed by anti-tubercular drugs.
Assuntos
Antituberculosos/administração & dosagem , Ossos Metacarpais/microbiologia , Tuberculose Osteoarticular/diagnóstico , Pré-Escolar , Feminino , Humanos , Ossos Metacarpais/patologia , Tuberculose Osteoarticular/tratamento farmacológico , Tuberculose Osteoarticular/patologiaRESUMO
Skeletal tuberculosis (TB) of the hand and wrist is rare, accounting for less than 1% of all osteoarticular TB. Although rare, TB of the hand and wrist is a cause of major morbidity. A common feature among all available reports on TB of the hand and wrist was a delay in diagnosis, causing residual stiffness and pain after treatment. Minimal initial symptoms, rarity of the lesion and ability of wrist TB to mimic more common pathologies account for the delay. Skeletal TB may behave differently in this age compared with the adult population. Further, the disease may affect the growing bone, causing residual deformities. The paucity of studies from different countries, coupled with a difficulty in diagnosis resulting in major morbidity, led us to carry out a study on this topic. A total of 44 patients with skeletal lesions in the hand and wrist were studied. The diagnosis was confirmed by biopsy. Patients were started on multidrug antitubercular treatment (ATT). Those not responding were scheduled for debridement. All patients were assessed using the Green O'Brian scoring system. All these patients were studied separately for clinical presentation, nutritional status (Rainey-Mcdonald nutritional index), time from onset of symptoms to presentation, treatment required, prognosis and complications. The proximal phalanx of the fourth digit and the metacarpal of the fifth digit were the most commonly involved bones in our series, with five cases of each. The capitate was the most common carpal bone, followed by the lunate. The duration of symptoms ranged from 5 weeks to 24 weeks (mean: 7.6 weeks). Most of these patients presented with complaints of pain, followed by swelling. 13 patients did not respond favourably to ATT over an 8-week period and were scheduled for surgery. Three of these patients had multidrug resistance. There was one case of a pathological fracture in our series and seven cases of arthritis/residual significant pain at the end of follow-up. For all the other patients, the results were excellent. A very high index of suspicion, MRI and early biopsy are required for a timely diagnosis of skeletal TB of the hand and wrist. Early commencement of ATT was the most important factor for good results. The possibility of multidrug resistance should be kept in mind for patients not responding to treatment.
Assuntos
Antituberculosos/uso terapêutico , Mãos/microbiologia , Tuberculose Osteoarticular/tratamento farmacológico , Articulação do Punho/microbiologia , Punho/microbiologia , Adolescente , Biópsia , Ossos do Carpo/microbiologia , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Ossos Metacarpais/microbiologia , Fatores de Tempo , Tuberculose Osteoarticular/diagnóstico por imagemAssuntos
Doença Granulomatosa Crônica/patologia , Ossos Metacarpais/patologia , Osteomielite/patologia , Infecções por Serratia/patologia , Antibacterianos/uso terapêutico , Doença Granulomatosa Crônica/microbiologia , Humanos , Lactente , Masculino , Ossos Metacarpais/microbiologia , Ossos Metacarpais/cirurgia , Osteomielite/microbiologia , Serratia marcescensAssuntos
Coccidioides/isolamento & purificação , Coccidioidomicose/patologia , Ossos Metacarpais/patologia , Osteomielite/diagnóstico , Abscesso/microbiologia , Abscesso/patologia , Abscesso/cirurgia , Acetamidas/uso terapêutico , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Coccidioidomicose/microbiologia , Coccidioidomicose/terapia , Fluconazol/uso terapêutico , Granuloma/microbiologia , Granuloma/patologia , Humanos , Linezolida , Imageamento por Ressonância Magnética , Masculino , Ossos Metacarpais/diagnóstico por imagem , Ossos Metacarpais/microbiologia , Pessoa de Meia-Idade , Osteomielite/microbiologia , Osteomielite/terapia , Oxazolidinonas/uso terapêutico , Radiografia , Resultado do TratamentoRESUMO
Metacarpal tuberculosis is a very rare form of the disease; it represents 1% of all bone sites. The diagnosis is often difficult because of the non-specific nature of the clinical examination and X-rays. Specialised morphological investigations are a capital contribution, but histology is diagnostic. Specific chemotherapy, combined with a bony debridement, generally allows desiccation of the bacilli in the lesions and the fixation of bone lesions. We report a case with the intention of pointing out the rarity of this location, the difficulty of diagnosis that may be encountered, and to highlight the severity of bone lesions that are mainly due to their late diagnosis.
Assuntos
Ossos Metacarpais/microbiologia , Ossos Metacarpais/patologia , Tuberculose Osteoarticular/diagnóstico , Adulto , Antituberculosos/uso terapêutico , Biópsia , Neoplasias Ósseas/diagnóstico , Desbridamento , Diagnóstico Tardio , Diagnóstico Diferencial , Seguimentos , Humanos , Masculino , Índice de Gravidade de Doença , Resultado do Tratamento , Tuberculose Osteoarticular/tratamento farmacológico , Tuberculose Osteoarticular/patologia , Tuberculose Osteoarticular/cirurgiaAssuntos
Antituberculosos/uso terapêutico , Ossos Metacarpais/microbiologia , Tuberculose Osteoarticular/diagnóstico por imagem , Tuberculose Osteoarticular/tratamento farmacológico , Idoso , Biópsia , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Masculino , Ossos Metacarpais/diagnóstico por imagem , RadiografiaRESUMO
OBJECTIVE: To describe and discuss previously unreported complications associated with intraosseous perfusion with gentamicin in horses. STUDY DESIGN: Case report. ANIMALS: Ten-year-old Warmblood gelding. METHODS: Intraosseous perfusion with gentamicin into the proximal phalanx (P1) was used as part of the treatment regimen for distal interphalangeal joint and navicular bursa synovial sepsis. Although the sepsis responded favorably complications developed at the perfusion site, including persistent osteomyelitis, progressive osteonecrosis, and ultimately pathologic fracture of P1. RESULTS: The progression of the clinical signs and findings at necropsy are suggestive of a toxic osteonecrosis secondary to intraosseous perfusion. CONCLUSIONS: Further work is needed to investigate the effects of high dose gentamicin on equine mesenchymal cells that may be achieved during intraosseous perfusion. CLINICAL RELEVANCE: Lower doses of perfusate within the medullary canal of P1 or alternative perfusion sites should be considered.