Skeletal Muscle Tuberculosis in an Immunocompetent Patient

Dabó, Hans; Mineiro, Ana; Carmelino, Janine; Carvalho, A.; Gomes, Conceição

doi:10.1016/j.arbr.2015.10.013

Cited by 4 publications

(2 citation statements)

References 2 publications

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“…The literature search yielded 280 articles, of which 52 articles (Fig. 3) reporting 67 cases were included for review; these comprised case series of 2 to 10 patients 2–6 and many case reports, 7–53 thus including the index case reported by us; 68 cases of primary tuberculous myositis were analyzed. A majority were Asian (69%), and mean age at presentation was 38.7 (±18.6) years (Supplemental Table 1, http://links.lww.com/RHU/A221).…”

Section: Results Of the Systematic Reviewmentioning

confidence: 99%

Primary Tuberculous Myositis—Report of a Case and Systematic Review of Literature in the Last 25 Years

et al. 2020

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M ycobacterium tuberculosis infects approximately 1.7 billion people in the world and causes disease in 10 million annually. Musculoskeletal tuberculosis accounts for 2% to 5% of cases, generally presenting as Pott's spine or large joint arthritis 1 ; the involvement of muscle by tubercle bacilli, referred to as tuberculous myositis, is rare. Muscle involvement can occur either due to hematogenous spread (primary) or as a result of extension from a contiguous site (secondary); the former being less common. 2 We report a case of primary tuberculous myositis and review all cases published in the last 25 years. CASE REPORTA 49-year-old man was admitted with swelling and dullaching pain over the right gluteal region, fever, and loss of appetite for 6 months. Three years prior to the current presentation, he had been diagnosed with dermatomyositis and treated with corticosteroids and azathioprine; these drugs were tapered and stopped after 2 years. With a possibility of relapse, corticosteroids were restarted 1 month before his admission.On examination, a localized tender swelling was present over the right gluteal area and posterior thigh, extending to the knee. Magnetic resonance imaging of this region revealed active myositis of the gluteal muscle and muscles in the posterior compartment of the right thigh (Figs. 1A, B). Positron emission tomographycomputed tomography showed uptake in these muscles, and an image-guided biopsy was performed. This revealed granulomatous inflammation on histopathology (Fig. 2), and a cartridge-based nucleic acid amplification test GeneXpert MTB/RIF (Cepheid, Sunnyvale, CA) detected M. tuberculosis. Computed tomography of the thorax did not show any pulmonary tuberculosis; however, tuberculin skin test was positive. Antitubercular therapy was started with isoniazid, rifampicin, ethambutol, and pyrazinamide for 2 months, followed by isoniazid, rifampicin, and ethambutol for 8 months. The fever resolved within 2 weeks, and over the next few months, the swelling subsided, and the patient gained weight. At 1 year, he was found to be asymptomatic and disease-free. METHODS FOR SYSTEMATIC REVIEWWe carried out a search in PubMed (MEDLINE), Scopus, EMBASE, and Web of Science, using the words "tubercular myositis," "tubercular pyomyositis," "tuberculous myositis," or "tuberculous pyomyositis." This review was restricted to articles in English language that were published between January 1995 and December 2019. Abstracts and full texts of relevant articles were examined by 2 authors (H.S., V.D.), and those articles that described cases of primary tuberculous myositis confirmed by microbiological tests (or on histopathology) were included for review. The outcome of cases was noted, factors associated with death analyzed, and odds ratios (ORs) (95% confidence intervals [CIs]) calculated. Analysis was done by GraphPad Prism (version 8 for Windows, La Jolla, CA).

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Section: Results Of the Systematic Reviewmentioning

confidence: 99%

Primary Tuberculous Myositis—Report of a Case and Systematic Review of Literature in the Last 25 Years

et al. 2020

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“…Skeletal muscles are not known to get involved even in cases of disseminated tuberculosis (7) as skeletal muscle is considered to be an unfavorable site for the survival of mycobacteria reasoning out why this type of TB is rare (7,8,9). According to literature though rare, the skeletal muscles which were involved in the course of TB were the pelvic muscles, anterior abdominal wall muscles and paraspinal muscles where the infection was due to secondary spread from bone or joint infection (7,9,10).…”

Section: Discussionmentioning

confidence: 99%

Extrapulmonary tuberculosis presenting as a dumbbell tumour of the chest wall

Kariyawasam¹,

Fonseka

Rasnayake

et al. 2019

Galle Med J

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Case report: Muscular tuberculosis with lower-extremity muscular masses as the initial presentation: Clinicopathological analysis of two cases and review of the literature

et al. 2023

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BackgroundTuberculosis (TB) is a threat to public health that mostly affects people in developing countries. TB presenting as a soft tissue mass is rare and is usually seen in patients with muscular tuberculosis (MT).Case presentationIn this study, we present the clinical, radiographic, and pathological features of two cases and retrospective evaluations of an additional 28 patients who were diagnosed with MT. More patients were men (60.9%) than women (39.1%), with a male-to-female ratio of 1.6:1. The average age among male and female patients was 38.9 and 30.1 years, respectively. MT usually presents with painful or painless muscular nodules on the lower limbs. Imaging findings, including ultrasound, CT, and MRI, can be used to identify lesions and sites for biopsy. The most typical histopathological feature of MT is granulomatous inflammation with caseous necrosis and epithelioid granulomata. Acid-fast bacilli stain and polymerase chain reaction (PCR) assays are helpful in identifying tubercle bacillus.ConclusionWe describe two MT cases with lower-extremity muscular masses as the initial presentation. The results suggest that muscle biopsy and pathological analysis remain necessary for diagnosis. Most of the patients could be cured with standard antituberculosis therapy.

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Skeletal Muscle Tuberculosis in an Immunocompetent Patient

Cited by 4 publications

References 2 publications

Primary Tuberculous Myositis—Report of a Case and Systematic Review of Literature in the Last 25 Years

Primary Tuberculous Myositis—Report of a Case and Systematic Review of Literature in the Last 25 Years

Extrapulmonary tuberculosis presenting as a dumbbell tumour of the chest wall

Case report: Muscular tuberculosis with lower-extremity muscular masses as the initial presentation: Clinicopathological analysis of two cases and review of the literature

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