European Society of Mycobacteriology - Instituto Nacional de Saúde ...
European Society of Mycobacteriology - Instituto Nacional de Saúde ...
European Society of Mycobacteriology - Instituto Nacional de Saúde ...
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PP-79<br />
OSSEOUS TUBERCULOSIS AT AGE OF 9 MONTHS<br />
Loureiro, Carla 1 , Matos, Gabriel 1 , Balacó, Inês 1 , Mota, Marta 2 , Nogueira, Célia 2 , Lemos, Sónia 1 , Rocha, Graça 1<br />
1. Pediatric Department/H. Pediatrico, CHC<br />
2. Mycrobiology Laboratory, Coimbra Medicine Faculty<br />
Background and Aims<br />
Osseous tuberculosis is rare, mainly as a primary disease in a previously healthy infant. Several mycobacteria may be<br />
involved such as M. tuberculosis, M. bovis and M. avium. When there is no association with a primary pulmonary disease<br />
in a child vaccinated with Calmet-Guérin Bacillus, M. bovis may be the causal agent.<br />
Case Report<br />
A previously healthy 11 month-old infant BCG vaccinated at birth was admitted with a 2 month evolution <strong>of</strong> a right elbow<br />
tumefaction. The X-ray presented <strong>de</strong>struction <strong>of</strong> the trochea, severe periostic reaction and s<strong>of</strong>t tissue tumefaction, and<br />
the ecography a fluid-filled cavity. MRI suggested neuroblastoma or Ewing sarcoma. Sedimentation rate and specific enolase<br />
were elevated. On surgery a whitish s<strong>of</strong>t mass associated with necrotic fluid compressing the cubital nerve was found.<br />
The histological examination revealed characteristic features <strong>of</strong> caseum and allowed the diagnosis <strong>of</strong> osseous tuberculosis.<br />
Mycobacterium tuberculosis complex was i<strong>de</strong>ntified by Real-Time PCR in osseous biopsy. Gastric fluid and urine<br />
were negative. Our patient recovered after surgical <strong>de</strong>bri<strong>de</strong>ment and combination drug therapy. He <strong>de</strong>veloped a local<br />
cutaneous fistula (no agent i<strong>de</strong>ntified on fluid culture) and posterior s<strong>of</strong>t tissue calcification. At 22 months age he remains<br />
with no other relevant infections.<br />
Conclusions<br />
Skeletal tuberculosis with extravertebral location is rare. Tuberculous osteomyelites <strong>of</strong> the limb bones requires a high<br />
in<strong>de</strong>x <strong>of</strong> clinical suspicion along with radiological and histopathological investigation in or<strong>de</strong>r to establish the diagnosis.<br />
Tuberculosis is still an important differential diagnosis in unusual bone conditions<br />
<strong>European</strong> <strong>Society</strong> <strong>of</strong> <strong>Mycobacteriology</strong> | 30 th Annual Congress | July 2009 | Porto - Portugal<br />
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