Stingo Facundo E, Rodriguez-Fontan Francisco, Burger-Van der Walt Evalina, Arce Javier, Garcia Sebastian N, Munafo Ricardo M
CETEA, Buenos Aires, Argentina.
Department of Medicine, MedStar Washington Hospital Center/Georgetown University Hospital, School of Medicine, Washington, DC.
JBJS Case Connect. 2018 Apr-Jun;8(2):e31. doi: 10.2106/JBJS.CC.17.00183.
Following an insidious onset of symptoms, a 29-year-old man who had no risk factors for tuberculosis was diagnosed with tuberculosis of the iliac crest. The red flag in this case was the patient's progressive deterioration despite a variety of antibiotic regimens. Histopathologic demonstration of necrotic granulomatous inflammation and a positive culture led to the diagnosis. A combination of surgery and antitubercular-drug therapy resulted in clinical recovery.
Iliac crest tuberculosis represents <1% of all skeletal tuberculosis cases. Even in the absence of classic symptoms and risk factors, orthopaedic surgeons should maintain a low threshold for tuberculosis in the differential diagnosis.
