De Mulder Pieter, Harth Charlotte, Ide Louis, Vallaeys Jurgen, Baelde Nick, De Bo Thomas
a University Hospital of Ghent , Ghent , Belgium.
b Department of Microbiology , Jan Palfijn Hospital , Ghent , Belgium.
Acta Clin Belg. 2017 Oct;72(5):357-360. doi: 10.1080/17843286.2016.1271499. Epub 2017 Jan 11.
A 66-year-old Caucasian female presented with insidious sciatic pain leading to an uncommon diagnosis of tuberculous osteomyelitis with unknown portal entry. The patient did not report a history of a previous tuberculosis (TB) infection and her chest X-ray was negative for TB. Considering TB in the differential diagnosis of a 'bone abscess', it is of paramount importance to come to a correct diagnosis. Conventional radiographs still remain the first-line imaging modality for evaluation of skeletal symptomatology. However, biopsies or aspirates are often needed to yield the definitive diagnosis. The lack of awareness of the potential extrapulmonary involvement of TB leads to an important delay in diagnosis and treatment. Antituberculous drugs should be started at the time of biopsy and continued during 12-18 months, due to poor drug penetration into osseous and fibrous tissues.
一名66岁的白种女性因隐匿性坐骨神经痛就诊，最终被诊断为罕见的结核性骨髓炎，感染途径不明。患者既往无结核病感染史，胸部X线检查未发现结核病灶。在鉴别诊断“骨脓肿”时考虑到结核病，正确诊断至关重要。传统X线片仍是评估骨骼症状的一线影像学检查方法。然而，通常需要进行活检或抽吸检查才能做出明确诊断。对结核病可能累及肺外器官缺乏认识会导致诊断和治疗的重要延误。由于药物难以渗透到骨组织和纤维组织中，抗结核药物应在活检时开始使用，并持续使用12 - 18个月。
