Lopes Maria Juliana, Furtado Inês, Brandão Mariana, Farinha Fátima
Medicine Department, Centro Hospitalar do Porto, Porto, Portugal.
BMJ Case Rep. 2018 Feb 6;2018:bcr-2017-222136. doi: 10.1136/bcr-2017-222136.
Osteoarticular tuberculosis is the third most frequent location of tuberculosis after the lung and lymph nodes, accounting for approximately 10%-20% of all cases of extrapulmonary disease. Tuberculosis of the hand and wrist is the rarest osteoarticular location after the shoulder. The authors report the case of a 50-year-old woman without medical history who was diagnosed with isolated tuberculosis of the wrist presenting as monarthritis. The diagnosis was confirmed by histopathological and microbiological examination. Late stages of osteomyelitis are even rarer without any predisposing factors such as immunosuppression. This case underlines the importance of including tuberculosis in the differential diagnosis of monoarthritic syndromes to prevent delayed initiation of therapy and consequent complications and bone damage.
骨关节结核是继肺部和淋巴结之后结核病的第三大常见发病部位，约占所有肺外疾病病例的10%-20%。手部和腕部结核是继肩部之后最罕见的骨关节发病部位。作者报告了一例50岁无病史女性病例，该患者被诊断为以单关节炎形式出现的孤立性腕部结核。诊断通过组织病理学和微生物学检查得以证实。在没有免疫抑制等任何诱发因素的情况下，骨髓炎晚期更为罕见。该病例强调了在单关节炎综合征的鉴别诊断中纳入结核病的重要性，以防止治疗延迟启动及随之而来的并发症和骨损伤。
