Mota Patrícia Caetano, Sá David, Mota Margarida, Duarte Raquel
Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal.
BMJ Case Rep. 2011 Sep 19;2011:bcr0620114363. doi: 10.1136/bcr.06.2011.4363.
Patients with tuberculosis (TB) typically present with pulmonary TB, but extrapulmonary TB is also an important clinical problem. In particular, osteoarticular TB has a great morbidity and its diagnosis gold-standard includes culture and histopathology of the infected area. The present case study describes a 53-year-old female Portuguese farmer who had initial clinical and imaging features suggestive of tuberculous osteomyelitis. However, she denied any TB contacts and the tuberculin skin-test and interferon-γ release assay result were negative. Brucella melitensis was isolated from a tissue biopsy cultural examination, and treatment for brucellosis was started, yielding a favourable outcome. In similar circumstances, a precise diagnosis, that considers the epidemiological context, is crucially important for adequate treatment and reduction of morbidity.
肺结核（TB）患者通常表现为肺结核，但肺外结核也是一个重要的临床问题。特别是骨关节炎型结核发病率很高，其诊断金标准包括对感染部位进行培养和组织病理学检查。本病例研究描述了一名53岁的葡萄牙女性农民，她最初的临床和影像学特征提示为结核性骨髓炎。然而，她否认有任何结核病接触史，结核菌素皮肤试验和干扰素-γ释放试验结果均为阴性。从组织活检培养检查中分离出羊种布鲁氏菌，并开始进行布鲁氏菌病治疗，取得了良好效果。在类似情况下，结合流行病学背景进行准确诊断对于适当治疗和降低发病率至关重要。
