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PubMed2007

Tuberculosis of the spine presenting with a cold abscess through the lumbar triangle of Petit.

The increasing incidence of human immunodeficiency virus (HIV) has resulted in an increase in the number of Mycobacterium tuberculosis (TB) infections worldwide. Musculoskeletal tuberculosis often involves the spine. Due to HIV, patients may present atypically and, as a result, a high clinical suspicion is necessary to avoid the catastrophic consequences of untreated Pott's disease of the spine. A cold abscess as a result of tuberculosis can emerge in a number of anatomical regions, and perhaps most notably as a psoas abscess. We report a less common anatomical location of a cold abscess, presenting as a mass in the inferior lumbar region through the lumbar triangle of Jean-Louis Petit. We consider the route that the pus had followed and highlight the need for vigilance when dealing with an abscess in this region, particularly in communities with a high incidence of HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed1994

Multifocal musculoskeletal cystic tuberculosis without systemic manifestations.

A case of multifocal cystic tuberculosis is presented, affecting the clavicle and the iliac bones with considerable soft tissue involvement. It was found in a 34-year-old male, an immigrant from Yemen. The extensive cystic nature of both lesions and the lack of systemic manifestations despite multifocal disease are unusual.

Adult↗
PubMed1998

Tuberculous bursitis of the greater trochanter.

A patient with tuberculous bursitis of the greater trochanter is reported. A 37-year-old woman had experienced persistent dull hip pain and noticed diffuse swelling over the greater trochanteric region. Plain radiograph revealed unremarkable osteopenic changes in the greater trochanter and faint mineralization in the vicinity of the trochanter. Computed tomogram showed erosion of the trochanter and a large soft tissue mass. Magnetic resonance imaging demonstrated a large multicystic mass. Histology of the cyst wall, showing chronic granulomatous tissue, and a positive culture of Mycobacterium tuberculosis confirmed the diagnosis of musculoskeletal tuberculosis. Complete excision of the lesion, followed by 6 months of antituberculous chemotherapy with rifampicin and isoniazid, cured the disease. There has been no sign of recurrent disease in 30 months of follow-up. Correct diagnosis was difficult because of its rarity, but modern imaging technology, magnetic resonance imaging, in particular, was extremely useful for showing the extent of the disease. Tuberculous infection should be considered as a differential diagnosis in patients with persistent hip pain.

Adult↗
PubMed1991

Tuberculous tenosynovitis of the wrist. Two case reports.

Tuberculosis was first described in 1756 by Acrel in a case report. Subsequent reports of musculoskeletal tuberculosis documented the uncommon occurrence of hand and wrist involvement. The two cases presented here demonstrate the difficulty in eradicating the organism even with modern regimens of chemotherapy. Intraoperative Gram's stain and frozen sections were useful to rule out other etiologies. Firm diagnosis must be established by tissue culture. The first case appeared cured after thorough initial debridement and had no recurrence for 36 years. While recurrences are common in patients treated with debridement alone, most appear within one year after the index procedure. The amount of time that elapsed in this case is unusual and serves as a sobering reminder that tuberculosis may recur at a time distant from the initial procedure. The second patient had tuberculosis diagnosed elsewhere and was treated twice with antituberculous chemotherapy. Although the first course of therapy for six months may have been inadequate, the second course with multiple drugs for 18 months would certainly be considered adequate; yet he had a recurrence in his wrist eight months after completing treatment. These two cases illustrate the fastidious nature of the Mycobacterium tuberculosis organism and the need for a combined treatment protocol of meticulous surgical debridement and combined chemotherapy.

Aged↗
PubMed1976

Carpal tunnel syndrome as the initial manifestation of tuberculosis.

Two patients presenting with carpal tunnel syndrome as the initial manifestations of tuberculosis were seen during a recent four month period at a larg city-county hospital. Although the clinical picture of the carpal tunnel syndrome was typical, a definite diagnosis could not be made until the time of surgery because of the many other causes of the carpal tunnel syndrome. A review of the experience with musculoskeletal tuberculosis and carpal tunnel syndrome at our hospital indicates that although this combination is not common, it is one of the treatable causes of the carpal tunnel syndrome. A review of the literature substantiates this impression.

Aged↗
PubMed2005

Extraspinal osteoarticular tuberculosis: a forgotten entity?

Tuberculosis affects a significant percentage of the world's population and is responsible for bone and joint infections particularly in the developing world. The problem has been compounded by the HIV/ AIDS epidemic. Whereas tuberculous involvement of the spine is readily included in a list of differentials for destructive lesions of the spine, infection in other skeletal areas is often not considered. In endemic areas, physicians are aware of the clinical and radiological presentations of musculoskeletal tuberculosis. In non-endemic areas, this knowledge is often lacking. Diagnostic delay often results in increased morbidity and mortality. There is a need therefore to highlight extra-spinal osteoarticular tuberculosis as a real entity.

Acetabulum↗
PubMed1999

Tuberculous infection of the gracilis muscle and tendon clinically mimicking deep venous thrombosis: sonographic findings.

Musculoskeletal tuberculosis usually involves the spine. Tuberculous infection of muscles and tendons is rare. A patient with tuberculous infection of the gracilis muscle and tendon is reported. Lower extremity Doppler ultrasound was initially performed, as the physical examination mimicked deep vein thrombosis. Sonography identified the abnormal muscle and tendon and was then used to guide aspiration. The sonographic appearance of the gracilis muscle and tendon is described and compared with correlative MR images.

Adult↗
PubMed1995

Pediatric surgery between 1860 and 1900.

The twentieth century begins the modern era of pediatric surgery, a time of innovation and vastly improved operative survival. Until then, many correctable congenital anomalies had been described in case reports only as medical curiosities, seemingly having no chance for surgical cure, but the challenge was available to those wishing to accept. The first texts devoted to surgical diseases of infancy and childhood were descriptive, emphasizing visible and palpable lesions, tuberculosis, musculoskeletal deformity, and major trauma, but also recognized that "surgical diseases of children by their number, their variety, and their character must, we think, be studied in a special manner and demand a special chapter in surgical books." The construction of Children's Hospitals during the nineteenth century identified the need to provide special facilities for children. Surgical antisepsis was practiced and general anesthesia used. Physicians such as Hirschsprung recognized a wide spectrum of treatable surgical conditions that would soon become the domain of pediatric surgeons. Indeed, at that moment in time at the very beginning of the twentieth century, Roentgen discovered the x-ray, Ladd received his MD degree at Harvard, the first pediatric appendectomies for appendicitis were successfully performed, and Fredet and Ramstedt recognized that pyloroplasty was not the preferred treatment for hypertrophic pyloric stenosis. Modern pediatric surgery had passed from embryo to fetus to newborn.

Denmark↗
PubMed2002

Multifocal tubercular dactylitis in an adult.

Musculoskeletal tuberculosis (TB) is a rare manifestation of TB comprising 1%-3% of all cases. We describe a patient who had multiple manifestations of skeletal TB, including spondylitis, dactylitis, and Poncet's disease. The unusual features include multifocal dactylitis, widespread disease in the absence of any risk factor like HIV infection or immunosuppressive treatment, and absence of pulmonary lesion. Treatment with appropriate drugs, using 4 agents for the first 2 months, led to complete recovery. TB can rarely present in an unusual way but is very important to recognize, as with treatment it still carries a good prognosis.

Journal Article↗
PubMed1986

Perthes' disease. The family tree.

The discovery and use of roentgenograms by Wilhelm Röntgen in 1895 was one of the most important turning points in the history of orthopedics. Within only a few years, immense advances were made in the recognition and definition of bone and joint disorders that, until then, had been thought to be different or unusual forms of musculoskeletal tuberculosis. Perthes' disease has become one of the Lieblingsthema of orthopedics. The study of the history of Perthes' disease is fascinating: the sources of many "original" thoughts can be traced back across the world, through the years. This review begins with the 19th century, traces the emergence of the definition of Perthes' disease and some related conditions, and follows the story of the disease in the first decade of its history as a separate entity.

Femur Head Necrosis↗
PubMed1999

[Tuberculosis manifestations in the musculoskeletal system exemplified by Poncet's disease].

Tuberculosis is a communicable disease that is occasionally complicated by arthritis, either as part of a disseminated primary infection or through late reactivation, often in immunocompromised hosts such as elderly people, HIV-positive patients or patients under immunosuppressive therapy. Even though musculoskeletal manifestations occur in only about 2% of tuberculosis cases, they can be very heterogeneous and present as spondylitis, osteomyelitis or mono-oligo-polyarthritis. Because of the potential for disastrous outcomes in cases where the diagnosis is delayed, it is important to recognize the multiple rheumatological manifestations of tuberculosis. This case report on a patient with Poncet's disease discusses a current hypothesis regarding pathogenesis of reactive arthritis based on rheumatological manifestations of tuberculosis. The genomic detection of Mycobacterium tuberculosis, to differentiate between infectious arthritis and reactive arthritis by polymerase chain reaction, is of particular importance.

AIDS-Related Opportunistic Infections↗
PubMed2003

Advanced imaging of tuberculosis arthritis.

Musculoskeletal manifestations are seen in approximately 3% of tuberculosis (MTb) cases, more commonly in the spine. Extra-axial bone and joint MTb is infrequently encountered in the West. In the last decade, public health strategies for control of MTb have been so successful in industrialized countries that many clinicians are unfamiliar with the range of extrapulmonary manifestations of MTb and therefore hold a low index of suspicion for MTb in the diagnosis of bone and joint infection. MTb, however, persists as a serious and significant cause of musculoskeletal pathology in many parts of the world and for specific patient cohorts in industrialized countries. Knowledge of the patient groups at risk and awareness of the varied osteoarticular manifestations of MTb are essential for timely diagnosis and intervention and potential cure.

Developed Countries↗
PubMed1987

Granulomatous musculoskeletal disease: sarcoidosis versus tuberculosis.

A patient with systemic sarcoidosis insidiously developed tuberculous arthritis. The concurrence of these diagnoses in any individual patient is rare. Musculoskeletal features of sarcoidosis and tuberculosis are reviewed, and the importance of obtaining appropriate cultures to differentiate these granulomatous disorders is illustrated.

Adult↗
PubMed2006

A rare presentation of tuberculosis.

Primary involvement of the musculoskeletal system with tuberculosis is rare. We present a case of a young, immunocompetent woman with primary sternal tuberculosis. The disease led to destruction of the manubrium and a portion of the gladiolus and required extensive debridement and partial sternectomy, followed by musculocutaneous flap closure. Long-term postoperative management included four-drug antitubercular therapy.

Adult↗
PubMedDate not supplied

Imaging of chest wall disorders.

Pathologic processes that may involve the chest wall include congenital and developmental anomalies, inflammatory and infectious diseases, and soft-tissue and bone tumors. Many of these processes have characteristic radiologic appearances that allow definitive diagnosis. Sternal deformities can be visualized at radiography and their severity quantified with computed tomography (CT). In cervical rib, CT with multiplanar reconstruction may demonstrate relevant anatomic detail and the relationship between bone deformity and arterial compression. In Poland syndrome, radiography reveals an area of hyperlucency on the affected side, whereas CT demonstrates the absence of the greater pectoral muscle and clearly depicts associated musculoskeletal anomalies. Tuberculosis typically manifests at radiography and CT as osseous and cartilaginous destruction and soft-tissue masses with calcification and rim enhancement. Aspergillosis involving the chest wall manifests as pulmonary consolidations and permeative osteolytic changes of the rib and spine at CT and as an area of increased signal intensity at T2-weighted magnetic resonance (MR) imaging. Neurogenic tumors and hemangiomas also typically have high signal intensity at T2-weighted MR imaging. Apparent mass extension or unequivocal bone destruction seen at CT or MR imaging may indicate chest wall involvement by lymphoma. Radiologically, soft-tissue sarcomas typically appear as areas of soft-tissue density or attenuation, often associated with necrotic areas of low density or attenuation. At radiography, plasmacytoma typically manifests as well-defined, "punched-out" lytic lesions with associated extrapleural soft-tissue masses. Chondrosarcoma frequently appears as a large, lobulated excrescent mass arising from a rib with scattered flocculent calcifications characteristic of its cartilaginous mix. Familiarity with these radiologic features facilitates accurate diagnosis and optimal patient treatment.

Adolescent↗