A persistent case of tuberculosis of the pubic symphysis and pubic bone

Abstract

A case of a patient suffering from tuberculosis of the pubic symphysis and pubic bone is presented. There were no symptoms other than pain in the right groin area for 12 months. An X-ray of the pelvis showed an osteodestructive lesion of the pubic bone, and an MRI revealed an abscess formation of the pubic symphysis. Tissue samples were collected via CT-guided needle biopsy. Histological evaluation of tissue and analysis by PCR prompted the diagnosis of musculoskeletal tuberculosis. Despite antituberculous chemotherapy according to the current guidelines, the osteodestructive lesion progressed. This case highlights the difficulty of treating bone infections in general. Moreover, Mycobacterium tuberculosis as a rare causative agent of bone infections is discussed.

Notification of 6442 Cases of Bone Tuberculosis in Brazil: Epidemiological Profile From 2009 to 2018

“…Bone tuberculosis is triggered by the spread of M. tuberculosis hematogenously or through proximity to lymph nodes affected by caseous necrosis. [7][8][9][10][11] In Brazil, during the period studied, 41.5% of the 6,442 cases were concentrated in the Southeast region (n=2,676), which can be explained by better access to specialized health services for conducting diagnosis and its subsequent (and proper) notification. In addition, this region has great demographic density compared to the others, consequently increasing the absolute number of cases of pulmonary and extrapulmonary tuberculosis.…”

“…This is due to the diagnostic complexity and the need for imaging and laboratory examinations that are not available in the primary healthcare network, delaying case identification and diagnosis. 8,11 Only 12.1% (n=781) of cases have the concomitant pulmonary form. The higher occurrence of the extrapulmonary form (87.9%, n=5,661) makes diagnosis using the more accessible methods difficult, since most of the lesions are paucibacillary, i. e., are not identified by the AARB test.…”

Report of a Rare Case of Pubic Symphysis Tuberculosis in an Eight-Year-Old Child: An Unusual Presentation of the Disease

“…Despite the decline in tuberculosis cases and improved treatment success rates, tuberculosis remains a significant global health concern, particularly in the context of high co-infection rates in HIV-positive individuals and the emergence of multidrug-resistant Mycobacterium tuberculosis cell lines [8]. Due to its rarity, elusive detection, and the need for prolonged antibiotic therapy, musculoskeletal tuberculosis presents a considerable challenge, frequently resulting in treatment failures [9]. Following lymph nodes, osteoarticular tuberculosis is the second most common extrapulmonary tuberculosis presentation, accounting for approximately 13% of cases [3,10].…”