Pati Sananda, De Sangita, Ghosh Tarak Nath, Ghosh Mrinal Kanti
RMO Cum Clinical Tutor, Department of Paediatrics, Burdwan Medical College and Hospital, Burdwan 713104, West Bengal, India.
Department of Paediatrics, Burdwan Medical College and Hospital, Burdwan 713104, West Bengal, India.
Indian J Tuberc. 2017 Apr;64(2):136-140. doi: 10.1016/j.ijtb.2016.01.004. Epub 2016 Jun 16.
Tuberculosis is a major health problem in the developing world. One-third of children infected with Mycobacterium tuberculosis have extra pulmonary involvement. Skeletal tuberculosis occurs in 1-6% of them with vertebra being the commonest site. Pure tubercular osteomyelitis without joint involvement occurs in only 2-3% cases of osteoarticular tuberculosis. Common sites are femur, tibia, and fibula. Disseminated skeletal involvement is very rare in children (7%) and calvarial osteomyelitis is even rarer (1%). Here, we report a unique case of disseminated skeletal TB. A 7-year-old tribal girl with no evidence of immunodeficiency presented with multiple lytic lesions involving skull, sternum, and hip bone surprisingly sparing the joints and appendicular skeleton. There was no pulmonary involvement either. FNAC from all three swellings showed presence of acid-fast bacillus. Bone biopsy followed by culture in BACTEC further confirmed the diagnosis. There was complete resolution of the swellings after one year of anti-tubercular drug therapy.
结核病是发展中国家的一个主要健康问题。三分之一感染结核分枝杆菌的儿童有肺外受累情况。其中1% - 6%会发生骨结核，最常见的部位是脊椎。在骨关节结核病例中，仅有2% - 3%发生无关节受累的单纯结核性骨髓炎。常见部位是股骨、胫骨和腓骨。儿童中骨骼广泛受累非常罕见（7%），颅骨骨髓炎甚至更为罕见（1%）。在此，我们报告一例独特的播散性骨结核病例。一名7岁的部落女孩，无免疫缺陷证据，出现多处溶骨性病变，累及颅骨、胸骨和髋骨，令人惊讶的是关节和附属骨骼未受累。也没有肺部受累情况。对所有三处肿胀部位进行细针穿刺抽吸活检显示有抗酸杆菌。骨活检并在BACTEC中进行培养进一步确诊。抗结核药物治疗一年后，肿胀完全消退。
