Muradali D, Gold W L, Vellend H, Becker E
Department of Radiology, Toronto Hospital, Ontario, Canada.
Clin Infect Dis. 1993 Aug;17(2):204-9.
We report the clinical, microbiological, and radiological features of four cases of multifocal osteoarticular tuberculosis, and we review the management of this condition. In each case the initial clinical diagnosis was one of malignant disease, and the possibility of tuberculous bone infection was overlooked. There was neither clinical nor radiological evidence of pulmonary involvement in any case. Antituberculous chemotherapy was initiated in two instances on the basis of histopathologic findings compatible with tuberculous osteomyelitis; such treatment was delayed in the other two cases until the diagnosis was confirmed by culture. Antituberculous chemotherapy alone was successful in three cases, while the fourth case required emergency anterior spinal decompression as well. Two patients developed additional skeletal lesions after the initiation of appropriate antituberculous chemotherapy. Multifocal osteoarticular tuberculosis must be considered in the differential diagnosis of multiple destructive skeletal lesions in all patients from areas where tuberculosis is endemic. This condition may mimic malignant disease both clinically and radiologically.
我们报告了4例多灶性骨关节结核的临床、微生物学和放射学特征，并对该病的治疗进行了综述。在每例患者中，最初的临床诊断均为恶性疾病，结核性骨感染的可能性被忽视。所有病例均无肺部受累的临床及放射学证据。2例根据与结核性骨髓炎相符的组织病理学结果开始抗结核化疗；另外2例延迟治疗，直至培养确诊。单纯抗结核化疗在3例中取得成功，而第4例还需要紧急前路脊髓减压。2例患者在开始适当的抗结核化疗后出现了额外的骨骼病变。对于来自结核病流行地区的所有患者，在鉴别诊断多发性破坏性骨骼病变时，必须考虑多灶性骨关节结核。这种疾病在临床和放射学上可能类似于恶性疾病。
