Malik Sushma, Joshi Surekha, Tank J Sonali
Department of Pediatrics, TNMC & BYL Nair Hospital, Mumbai Central, Mumbai-400 008, Maharashtra.
Indian J Tuberc. 2009 Oct;56(4):220-4.
Cystic tuberculosis of the bone is a rare form of tuberculosis (TB) osteomyelitis associated with disseminated lesions. In children, the lesions involve the peripheral skeleton, are symmetric and less sclerotic while in adults, the lesions are axial and predominantly sclerotic. TB dactylitis and spina ventosa are the other common variants of TB osteomyelitis seen in children below five years. Here we report seven cases of cystic TB bone disease. There were three males and four females with age of diagnosis between 2-11 years. Most patients presented with localized swelling and pain. X-rays revealed classical cystic lesions and spina ventosa. Four children had multiple cystic lesions and three had isolated lesions. Diagnosis was confirmed by FNAC of the bone or histopathological/radiological evidence of TB. The patients responded well to anti-tubercular therapy. The entity of cystic TB bone disease should be borne in mind as, lack of awareness may delay diagnosis and treatment. Biopsy is mandatory to confirm diagnosis and antitubercular drugs are the mainstay of therapy. Curettage of affected bone in selected cases may promote early healing. Response to therapy is excellent and the overall prognosis is good.
骨囊性结核是一种罕见的结核性骨髓炎，与播散性病变相关。在儿童中，病变累及外周骨骼，呈对称性且硬化程度较低；而在成人中，病变位于轴向且主要为硬化性。结核性指炎和骨气臌是5岁以下儿童中常见的结核性骨髓炎的其他变体。在此，我们报告7例骨囊性结核病例。其中男性3例，女性4例，诊断年龄在2至11岁之间。大多数患者表现为局部肿胀和疼痛。X线显示典型的囊性病变和骨气臌。4名儿童有多个囊性病变，3名儿童有孤立性病变。通过骨细针穿刺抽吸活检（FNAC）或结核的组织病理学/放射学证据确诊。患者对抗结核治疗反应良好。应牢记骨囊性结核这一疾病，因为缺乏认识可能会延误诊断和治疗。活检对于确诊至关重要，抗结核药物是主要治疗手段。在某些病例中，对受累骨骼进行刮除术可能促进早期愈合。治疗反应良好，总体预后良好。
