Kerens B, Gans E H, Pilot P, van der Tempel H, Verburg A D
Maaslandziekenhuis, Postbus 5500, 6130 MB Sittard.
Ned Tijdschr Geneeskd. 2006 Aug 5;150(31):1728-31.
A 41-year-old man underwent skeletal scintigraphy due to chronic pain in the left foot and polyarthralgia. He was taking medication for gout and had previously had sarcoidosis, for which he had received corticosteroids and other therapy that was discontinued 4 years ago. Scintigraphy revealed a mass in the shaft of the left humerus that, according to biopsy, was an asymptomatic osteomyelitis caused by Mycobacterium avium. The shaft of the left humerus is an uncommon site for tuberculous osteomyelitis. A viable fistula remained after the biopsy that persisted despite pharmacologic treatment with ethambutol, rifabutin and clarithromycin. Four months later, sequestrectomy was performed with insertion of gentamicin-impregnated beads, which resulted in rapid resolution. The foot pain resolved spontaneously. The incidence of bone tuberculosis has increased over the last 2 decades. The most commonly affected sites are the spine and large joints. Infection with M. avium is sometimes involved. Because of the increasing incidence it is important to include mycobacterial infections in the differential diagnosis of focal bone lesions, especially when standard cultures are initially negative.
一名41岁男性因左脚慢性疼痛和多关节痛接受了骨骼闪烁扫描检查。他正在接受痛风治疗，既往有结节病，曾接受过皮质类固醇及其他治疗，4年前停药。闪烁扫描显示左肱骨干有一肿块，活检显示为鸟分枝杆菌引起的无症状骨髓炎。左肱骨干是结核性骨髓炎的罕见部位。活检后遗留一个有活性的瘘管，尽管使用乙胺丁醇、利福布汀和克拉霉素进行药物治疗，瘘管仍持续存在。4个月后，进行了死骨切除术并植入庆大霉素珠，病情迅速缓解。足部疼痛自行缓解。在过去20年中，骨结核的发病率有所上升。最常受累的部位是脊柱和大关节。有时会涉及鸟分枝杆菌感染。由于发病率上升，在局灶性骨病变的鉴别诊断中纳入分枝杆菌感染很重要，尤其是当标准培养最初为阴性时。
