Primary tubercular osteomyelitis of the sternum

Sharma, Suvasini; Juneja, Monica; Garg, Anju

doi:10.1007/bf02724085

Cited by 30 publications

(42 citation statements)

References 9 publications

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“…Close follow-up is advised in such patients to determine the need for surgical treatment. 14 The role of a history of TB is very important in such cases; however, in this presented case the patient and his parents denied positive history of the disease. The patient did not consider the disease as significant as he was quite young when he suffered from TB.…”

Section: Discussionmentioning

confidence: 81%

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Tuberculous osteomyelitis of mandibular condyle: a diagnostic dilemma

Sheikh¹,

Pallagatti²,

Gupta³

et al. 2012

Dentomaxillofacial Radiology

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The incidence of tuberculosis (TB) is increasing worldwide and so are its consequences. Its oral manifestations are infrequent, occurring in approximately 3% of all cases. Although the primary lesion occurs as a pulmonary infection, the extrapulmonary infections have also shown an increase over the past few years. These infections generally involve the head and neck through haematogenous or lymphatic routes. The clinical presentation may be as an ulcer, granuloma, orofacial TB, TB of the salivary glands or tuberculous lymphadenitis. Rarely, secondary oral manifestations associated with pulmonary infection are seen, which can appear as lesions on the gingiva, palate, lips, tongue, buccal mucosa, frenulum and in the jaw bones. Owing to the rarity of orofacial TB, it seldom arouses clinical suspicion, especially when a positive history of a systemic infection or therapy is denied. Tuberculous involvement of the mandibular condyle is even rarer, and only two such cases are reported so far, both in English-language literature. Further, the diagnosis of such a case is extremely difficult as there are no specific signs pathogonomic of infection. The only manifestation may be a localized painful swelling of the jaw. The presented case is of osteomyelitis of the mandibular condyle in a 20-year-old male patient in whom TB was later suspected. In this case report the role of diagnostic techniques is emphasized as the osteomyelitis of the condyle has the risk of being easily missed owing to its atypical signs and symptoms and atypical radiographic appearance. Dentomaxillofacial Radiology (2012) 41, 169-174. doi: 10.1259/dmfr/56238546 Keywords: tuberculosis; osteomyelitis; condyle Case reportA 20-year-old male patient presented with a gradually progressive swelling at the side of his face in front of the right ear for about 15 days (Figure 1). 2 months beforehand, there was a sudden onset of dull pain at the right temporomandibular joint (TMJ) region which aggravated during mouth opening; it was associated with reduced mouth opening. The patient's medical history was non-contributory. There was no history of any trauma to the TMJ region. He was moderately built and nourished, and afebrile at the time of examination. He otherwise reported weakness and malaise over the past month along with some weight loss. General physical and systemic examinations were unremarkable. All the vital signs were in normal range. He was a gutka chewer (a preparation of tobacco mixed with areca nut) and had chewed it 5-6 times a day for 3 years.Extraorally, a unilateral solitary swelling was seen at the right TMJ region measuring 1.5 6 1.5 cm in size. It was oval with normal overlying skin. On palpation, the swelling was firm, tender and non-fluctuant. There was a localized rise in temperature. Tenderness was elicited in the temporalis muscle of the same side with no obvious lymphadenopathy of the head and neck region. Intraorally, the buccal mucosa of the left side was opaque and blanched. There were no other significant findings. The occlusion w...

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Section: Discussionmentioning

confidence: 81%

“…Others believe that aggressive debridement with primary closure is required as an adjunct to chemotherapy to prevent recurrence or the formation of a draining sinus. 13,14 According to some authors, surgery is not indicated in smaller lesions. Close follow-up is advised in such patients to determine the need for surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

Tuberculous osteomyelitis of mandibular condyle: a diagnostic dilemma

Sheikh¹,

Pallagatti²,

Gupta³

et al. 2012

Dentomaxillofacial Radiology

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“…Tubercular involvement of the sternum is rarer even in countries where tuberculosis is highly prevalent [2]. We herein report an unusual case of tuberculous osteomyelitis of sternum with acute presentation as a swelling over anterior chest wall.…”

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confidence: 85%

Sternal Tuberculosis: An Uncommon Presentation

Narang¹,

Dwivedi²,

Narang³

et al. 2011

JCR

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Skeletal tuberculosis as an extrapulmonary entity is uncommon accounting for less than 7% cases [1]. Tubercular involvement of the sternum is rarer even in countries where tuberculosis is highly prevalent [2]. We herein report an unusual case of tuberculous osteomyelitis of sternum with acute presentation as a swelling over anterior chest wall.An eleven year old girl presented with one week history of chest pain and swelling over anterior chest wall. There was history of progressive weight loss and low grade intermittent fever for one month. She was BCG vaccinated and there was no history of contact with tuberculosis in the family.On examination, the child was febrile, with thin built, and weighed 35 kgs (<50th percentile). Local examination showed diffuse swelling over manubrium. The swelling was highly tender and fluctuant. There was no redness, localised rise of temperature or any venous prominence over the swelling. There was no lymphadenopathy. Systemic examination revealed dullness over bilateral lower chest with decreased breath sounds on corresponding areas. Other systems were found to be normal.Investigations revealed hemoglobin of 10.4gm/dl, erythrocyte sedimentation rate was elevated to 40 mm in 1st hour. Tuberculin test was strongly positive measuring 20 x 20 mm with negative HIV test. Chest x-ray showed bilateral pleural effusion. Computed tomography of the chest showed permeative destruction (lytic areas) of sternum along with extrapleural collection tracking all along the anterior mediastinum and encroaching on anterior clear space on sagittal views (Fig 1). Collection was extending anterior to the sternum into parities and there was evidence of mediastinal and hilar lymphadenopathy along with areas of pleural reaction (thickening in the left hemithorax) along the costal pleura (Fig 2). There was enlargement of subcarinal group of lymph nodes. Fat planes anterior to mediastinum under collection were maintained. Aspirate from swelling over manubrium sterni revealed positive culture for Mycobacterium tuberculosis and positive Zeil Neelsen staining for acid fast bacilli.The child was started on antitubercular treatment with four drugs viz isoniazid, rifampicin, ethambutol and pyrazinamide. The child showed dramatic improvement within a month of institution of treatment. The pain and swelling subsided. She was switched over to continuation phase with two drugs isoniazid and rifampicin. Abstract:Primary tubercular osteomyelitis of sternum presenting as an acute swelling over chest is an extremely rare presentation in pediatric population. We herein report such a case which was diagnosed by CT scan showing lytic lesion and aspiration revealed positive culture for Mycobacterium tuberculosis. Child improved with antitubercular treatment.Tubercular osteomyelitis, Sternum

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“…Patient recovered well at the end of the ATT course without any complication. Tuberculosis of sternum is a rare clinical entity with only few cases reported in literature [6][7][8][9]. Tuli and Sinha reported 14 (1.5%) cases of sternal tuberculosis out of total 980 cases of osteoarticular tuberculosis [10].…”

Section: Case Reportmentioning

confidence: 99%

Primary Tubercular Osteomyelitis of Manubrio Sternal Joint: A Case Report

Kumar¹

2015

Mycobact Dis

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Primary tubercular osteomyelitis of sternum is a rare clinical entity and involvement of manubrio-sternal joint is even rarer, with only few cases reported in the literature. Tuberculous sternal involvement is seen in approximately 1% of all skeletal TB cases. We report an unusual case of primary manubrio-sternal joint tuberculosis presenting as vague anterior chest wall swelling and pain. ESR and CRP were elevated, Montoux was positive and PCR for tuberculosis was positive. Computed tomography of chest done after giving intravenous contrast showed erosion at manubrio-sternal joint with minimal soft tissue component. The patient is put on anti-tubercular drugs and is responding well with regular follow-up.

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Primary tubercular osteomyelitis of the sternum

Cited by 30 publications

References 9 publications

Tuberculous osteomyelitis of mandibular condyle: a diagnostic dilemma

Tuberculous osteomyelitis of mandibular condyle: a diagnostic dilemma

Sternal Tuberculosis: An Uncommon Presentation

Primary Tubercular Osteomyelitis of Manubrio Sternal Joint: A Case Report

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