Kawasaki Takeshi, Sasaki Yuka, Shinozaki Aya, Bekku Rei, Hashimoto Tomohiro, Yagi Takenori, Yamagishi Fumio
Department of Thoracic Disease, National Hospital Organization Chiba-East National Hospital, 673 Nitona-cho, Chuo-ku, Chiba-shi, Chiba 260-8712, Japan.
Kekkaku. 2007 May;82(5):475-9.
Tuberculosis is seen in every part of the body, but sternoclavicular joint tuberculosis is rare. We report a case of tuberculosis of the sternoclavicular joint in 70-year-old woman having complained of the right sternoclavicular joint swelling. She had a previous history of pulmonary tuberculosis, and visited her doctor for right sternoclavicular joint swelling on February 2006. A chest CT scan showed a low density area with destructive osseous changes in the right sternoclavicular joint. Definite diagnosis could not be done by twice needle biopsy, but we diagnosed her as tuberculosis of the sternoclavicular joint based on the clinical course and the findings of the examination. As her condition did not improve after 3 months treatment with anti-tuberculous drugs, we conducted therapeutic surgical procedure. Definite diagnosis of sternoclavicular joint tuberculosis was made on the basis of the presence of mycobacteria in the histological specimen and PCR-TB positive result. We kept the wound opened and continued administration of anti-tuberculous drugs, and her condition does not deteriorate. Tuberculosis should be considered in case of a patient with arthritis and previous history of tuberculosis, even if it is seen in rare location. Diagnostic and therapeutic surgical procedure should be taken into consideration, if there is no improvement of the condition after a diagnosis of bone and joint tuberculosis, and the administration of chemotherapy for tuberculosis.
结核病可见于身体的各个部位,但胸锁关节结核较为罕见。我们报告一例70岁女性胸锁关节结核病例,该患者主诉右胸锁关节肿胀。她既往有肺结核病史,于2006年2月因右胸锁关节肿胀就诊。胸部CT扫描显示右胸锁关节处有低密度区伴骨质破坏改变。两次针吸活检均未能明确诊断,但根据临床病程和检查结果,我们诊断她为胸锁关节结核。在抗结核药物治疗3个月后病情未见改善,我们进行了治疗性手术。根据组织学标本中存在分枝杆菌以及PCR - TB阳性结果明确诊断为胸锁关节结核。我们让伤口敞开并继续给予抗结核药物,她的病情没有恶化。对于有关节炎且有结核病史的患者,即使病变部位罕见,也应考虑结核病。如果在诊断为骨与关节结核并给予抗结核化疗后病情无改善,应考虑诊断性和治疗性手术。