Nakazawa Yuka, Nishino Tomoya, Mori Atsushi, Uramatsu Tadashi, Obata Yoko, Arai Hideyuki, Hayashi Hideyuki, Tsukasaki Shoko, Muraya Yoshiaki, Inoue Yuichi, Yamamoto Yoshihiro, Kohno Shigeru
The Second Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
Intern Med. 2013;52(1):135-9. doi: 10.2169/internalmedicine.52.8437. Epub 2013 Jan 1.
A 76-year-old woman on hemodialysis (HD) presented with pain and swelling in the left wrist and forearm. The osteomyelitis occurred in the part of the ulna adjacent to the arteriovenous fistula. Mycobacterium tuberculosis was identified in pus obtained from the left forearm, leading to a diagnosis of tuberculous osteomyelitis. The patient was treated with anti-tuberculous drugs and her symptoms improved. In this study, we report a case of tuberculous osteomyelitis occurring in the ulna, which is not the usual site of predilection for tuberculosis infection. As HD patients exhibit a high frequency of extrapulmonary tuberculosis, tuberculous osteomyelitis should be considered in the differential diagnosis of infectious osteomyelitis. In addition, it may be useful to perform stab cultures at an early stage in order to diagnose tuberculous osteomyelitis.
一名76岁接受血液透析（HD）的女性患者出现左腕和前臂疼痛及肿胀。骨髓炎发生在与动静脉瘘相邻的尺骨部位。从左前臂获取的脓液中鉴定出结核分枝杆菌，从而诊断为结核性骨髓炎。患者接受抗结核药物治疗后症状改善。在本研究中，我们报告了一例发生在尺骨的结核性骨髓炎病例，而尺骨并非结核感染的常见好发部位。由于血液透析患者肺外结核的发生率较高，在感染性骨髓炎的鉴别诊断中应考虑结核性骨髓炎。此外，早期进行穿刺培养可能有助于诊断结核性骨髓炎。
