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Multifocal tuberculosis presenting with osteoarticular and breast involvement.

Bodur H, Erbay A, Bodur H, Yilmaz O, Kulacoglu S - Ann. Clin. Microbiol. Antimicrob. (2003)

Bottom Line: Polyarticular involvement, wrist and ankle arthritis are uncommon presentation of skeletal tuberculosis.In general, tuberculosis arthritis is a frequently missed diagnosis, especially in different clinical patterns.A high level of suspicion is required particularly in high-risk populations and endemic areas.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Infectious Disease and Clinical Microbiology, Ankara Numune Education and Research Hospital, Ankara, Turkey. aerbay@superonline.com

ABSTRACT

Background: Polyarticular involvement, wrist and ankle arthritis are uncommon presentation of skeletal tuberculosis. Tuberculosis of the breast is also extremely rare.

Case presentation: Wrist, ankle and breast involvement were detected in the same patient. Mycobacterium tuberculosis was isolated from both synovial and breast biopsy specimen cultures.

Conclusions: In general, tuberculosis arthritis is a frequently missed diagnosis, especially in different clinical patterns. A high level of suspicion is required particularly in high-risk populations and endemic areas.

No MeSH data available.


Related in: MedlinePlus

MR imaging of left ankle. Effusion and arthritis at tibiotalocalcaneal joint, and osteomyelitis at talus and calcaneus
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Figure 2: MR imaging of left ankle. Effusion and arthritis at tibiotalocalcaneal joint, and osteomyelitis at talus and calcaneus

Mentions: A 40 years old female patient was admitted with chronic arthritis. Her complaints have begun with swelling and pain on left wrist, eight years ago. At the peak stage of her complaints, restriction of motion developed and white coloured pus drained from volar site of the left hand. She had swelling and pain at her left ankle a year ago. Six months ago her left ankle was twisted. As a consequence, she had difficulty in walking. She did not define fever. She had night sweats during the last 4 months. Additionally, she detected a mass at her left breast 3 moths ago. In physical examination, 3 × 3 cm sized mobile and painless mass was detected at the left breast. Left wrist motions were restricted and painful; two scar lesions were present at volar site probably due to the previous drainage that took place in the history. Left ankle was swollen and painful. Through the follow up, she had night sweats but did not have any fever. Laboratory examination results were: ESR was 70 mm/h, WBC 6700/mm3, Hb 12.2 g/dl, platelet 231000/mm3, CRP 48 mg/dl (normal range <5). The outcome of biochemical tests and urine analysis were normal. Chest x-ray was normal. PPD (5 Todd unit) was performed and 35 mm of induration was measured. Left wrist x-ray showed bone destruction at distal ulna, radiocarpal and intercarpal bones (Figure 1). Periarticular osteoporosis was seen at left ankle x-ray. Magnetic resonance imaging (MRI) demonstrated effusion and contrast enhancement at tibiotalocalcaneal joint and osteomyelitis at talus and calcaneus (Figure 2). Mammography and ultrasonography showed a mass consisted of solid and a cystic component, which was measured to be 30,6 × 22,9 mm in diameter. Synovial biopsy from left ankle and excisional biopsy from left breast were performed. Histopathological examination revealed caseous and granulamatous infection compatible with TB. These samples were cultured in Löwenstein-Jensen culture media and growth was observed at the 4th week. The isolated strains were sent to the national reference laboratory (Refik Saydam Hifzissihha Laboratory, Ankara, Turkey) for confirmation and susceptibility test, and both of them were defined as Mycobacterium tuberculosis. It was reported susceptible to rifampin (RMP), isoniazid (INH), ethambutol (EMB) and streptomycin (STM). INH (300 mg/d), RMP (600 mg/d), PZA (3 gr/d) and STM (1 gr/d) were given for treatment. At the 4th week the patient was improved and discharged. After two months, the therapy was continued with INH and RMP up to 9 months. After the cessation of therapy, in one year follow up the patient did not have any evidence of recurrence.


Multifocal tuberculosis presenting with osteoarticular and breast involvement.

Bodur H, Erbay A, Bodur H, Yilmaz O, Kulacoglu S - Ann. Clin. Microbiol. Antimicrob. (2003)

MR imaging of left ankle. Effusion and arthritis at tibiotalocalcaneal joint, and osteomyelitis at talus and calcaneus
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC153487&req=5

Figure 2: MR imaging of left ankle. Effusion and arthritis at tibiotalocalcaneal joint, and osteomyelitis at talus and calcaneus
Mentions: A 40 years old female patient was admitted with chronic arthritis. Her complaints have begun with swelling and pain on left wrist, eight years ago. At the peak stage of her complaints, restriction of motion developed and white coloured pus drained from volar site of the left hand. She had swelling and pain at her left ankle a year ago. Six months ago her left ankle was twisted. As a consequence, she had difficulty in walking. She did not define fever. She had night sweats during the last 4 months. Additionally, she detected a mass at her left breast 3 moths ago. In physical examination, 3 × 3 cm sized mobile and painless mass was detected at the left breast. Left wrist motions were restricted and painful; two scar lesions were present at volar site probably due to the previous drainage that took place in the history. Left ankle was swollen and painful. Through the follow up, she had night sweats but did not have any fever. Laboratory examination results were: ESR was 70 mm/h, WBC 6700/mm3, Hb 12.2 g/dl, platelet 231000/mm3, CRP 48 mg/dl (normal range <5). The outcome of biochemical tests and urine analysis were normal. Chest x-ray was normal. PPD (5 Todd unit) was performed and 35 mm of induration was measured. Left wrist x-ray showed bone destruction at distal ulna, radiocarpal and intercarpal bones (Figure 1). Periarticular osteoporosis was seen at left ankle x-ray. Magnetic resonance imaging (MRI) demonstrated effusion and contrast enhancement at tibiotalocalcaneal joint and osteomyelitis at talus and calcaneus (Figure 2). Mammography and ultrasonography showed a mass consisted of solid and a cystic component, which was measured to be 30,6 × 22,9 mm in diameter. Synovial biopsy from left ankle and excisional biopsy from left breast were performed. Histopathological examination revealed caseous and granulamatous infection compatible with TB. These samples were cultured in Löwenstein-Jensen culture media and growth was observed at the 4th week. The isolated strains were sent to the national reference laboratory (Refik Saydam Hifzissihha Laboratory, Ankara, Turkey) for confirmation and susceptibility test, and both of them were defined as Mycobacterium tuberculosis. It was reported susceptible to rifampin (RMP), isoniazid (INH), ethambutol (EMB) and streptomycin (STM). INH (300 mg/d), RMP (600 mg/d), PZA (3 gr/d) and STM (1 gr/d) were given for treatment. At the 4th week the patient was improved and discharged. After two months, the therapy was continued with INH and RMP up to 9 months. After the cessation of therapy, in one year follow up the patient did not have any evidence of recurrence.

Bottom Line: Polyarticular involvement, wrist and ankle arthritis are uncommon presentation of skeletal tuberculosis.In general, tuberculosis arthritis is a frequently missed diagnosis, especially in different clinical patterns.A high level of suspicion is required particularly in high-risk populations and endemic areas.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Infectious Disease and Clinical Microbiology, Ankara Numune Education and Research Hospital, Ankara, Turkey. aerbay@superonline.com

ABSTRACT

Background: Polyarticular involvement, wrist and ankle arthritis are uncommon presentation of skeletal tuberculosis. Tuberculosis of the breast is also extremely rare.

Case presentation: Wrist, ankle and breast involvement were detected in the same patient. Mycobacterium tuberculosis was isolated from both synovial and breast biopsy specimen cultures.

Conclusions: In general, tuberculosis arthritis is a frequently missed diagnosis, especially in different clinical patterns. A high level of suspicion is required particularly in high-risk populations and endemic areas.

No MeSH data available.


Related in: MedlinePlus