Sapmaz Feride, Katrancioğlu Ozgür, Gönlügür Tanseli, Gönlügür Uğur, Hasbek Mürşit
Sivas Numune Hastanesi, Göğus Cerrahisi Kliniği, Sivas.
Mikrobiyol Bul. 2008 Jul;42(3):503-7.
Isolated involvement of the sternum is rare, representing less than 1% of tuberculous osteomyelitis. In this report, a 51-years-old woman who was admitted to the hospital with a localized solid mass in the sternum has been presented. A soft, painful mass measuring 3 cm in diameter in the lower sternum was detected during physical examination. Radiological investigation revealed presternal soft tissue and bone expansion in the posterior side of lower sternum. The patient was treated with non-specific antibiotics for a suspected diagnosis of osteomyelitis but the lesion did not show any regression. Since the microbiological analysis of fine needle aspiration fluid demonstrated acid-fast bacilli in direct microscopy and Mycobacterium tuberculosis was isolated from the culture, anti-tuberculous therapy consisting of isoniazid (INH), rifampicin (RIF), pyrazinamide (PZA), and ethambutol (ETM) was started. Sputum and urine cultures of the patient yielded negative results in terms of tuberculosis. After the first month of the therapy, her skin lesion was completely healed. Since the strain was found to be resistant to isoniazid, the maintenance therapy has been applied as INH + RIF + PZA for nine months. The history of the patient indicated that one of her relatives had skin tuberculosis on the face. As a result the patient has been successfully treated with anti-tuberculosis combination therapy together with surgical debridement.
胸骨单独受累较为罕见，占结核性骨髓炎的比例不到1%。在本报告中，介绍了一名51岁女性，因胸骨出现局限性实性肿块入院。体格检查发现胸骨下部有一个直径3厘米、质地柔软且有压痛的肿块。影像学检查显示胸骨前软组织及胸骨下部后侧骨质膨胀。该患者因疑似骨髓炎接受了非特异性抗生素治疗，但病变未见任何消退。由于细针穿刺抽吸液的微生物分析在直接显微镜检查中显示抗酸杆菌，且培养物中分离出结核分枝杆菌，遂开始使用由异烟肼（INH）、利福平（RIF）、吡嗪酰胺（PZA）和乙胺丁醇（ETM）组成的抗结核治疗。患者的痰液和尿液培养结果在结核方面均为阴性。治疗第一个月后，她的皮肤病变完全愈合。由于发现该菌株对异烟肼耐药，维持治疗采用INH + RIF + PZA持续九个月。患者病史显示其一名亲属面部患有皮肤结核。结果，该患者通过抗结核联合治疗及手术清创成功治愈。
