Tuberculotic osteomyelitis of rib - a surgical entity

Agrawal, Vivek; Joshi, Mohit; Jain, Bhupendra Kumar; Mohanty, Debajyoti; Gupta, Arun

doi:10.1510/icvts.2008.179127

Cited by 20 publications

(21 citation statements)

References 9 publications

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“…As well as this, Yao, in a large series of 712 cases, spanning 11 years, advocates surgical treatment for parietal chest wall TB 18. Agrawal is of the opinion that treatment for bone TB requires a minimum of 12 months of anti tubercular treatment and this is further reinforced in other Indian studies 19 20…”

Section: Discussionmentioning

confidence: 96%

Unusual cause of chest pain: empyema necessitans and tubercular osteomyelitis of the rib in an immunocompetent man

et al. 2016

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SUMMARYA 33-year-old man, born in India but resident in the UK for 5 years, presented to the emergency department with a 4-week history of a dry cough and right-sided pleuritic chest pain. He reported systemic features, including fever and unintentional weight loss. His medical history included vitamin D deficiency. He had travelled to India 10 months previously and denied any exposure to tuberculosis (TB). He was an ex-smoker with a 20 pack history. Respiratory examination confirmed decreased air entry of the right lower lobe and stony dullness on percussion. His C reactive protein was 178 mg/L. A chest radiograph identified a moderate-sized right-sided pleural effusion and destruction of the lateral aspect of the right fifth rib, strongly suggestive of underlying malignancy. Further investigation with a CT of the thorax identified a focal lytic lesion in the right fifth rib, at its lateral aspect, with expansion of the rib observed. Ultrasound-guided pleural aspiration confirmed an exudative pleural effusion. Gram stain revealed no organisms or polymorphs. Four days post admission, the patient was transferred to the regional thoracic surgery unit and underwent videoassisted thoracic surgery, bronchoscopy and drainage of his empyema. His Mantoux tuberculin skin test and his TB Elispot were negative, suggesting that TB infection was unlikely. Culture confirmed no growth after 48 h incubation. Histology of his pleural biopsy identified multiple non-confluent necrotising granulomatous inflammation with very occasional acid-alcohol-fast bacilli-like organisms, highly suspicious for mycobacterial infection. The isolate, Mycobacterium tuberculosis, was identified by Accuprobe and HAIN tests, respectively. MPT64 erythrocyte sedimentation rate (ESR) results from the fifth rib were positive for M. tuberculosis. This case report discusses the aetiology, clinical presentation and pathophysiology of both empyema necessitans and tubercular osteomyelitis of the rib. BACKGROUND

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Section: Discussionmentioning

confidence: 96%

Unusual cause of chest pain: empyema necessitans and tubercular osteomyelitis of the rib in an immunocompetent man

et al. 2016

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“…Surgery may help in establishing the diagnosis or treating complications [8]. In a series of seven children with TB osteomyelitis of the rib, surgery was indicated, as all presented with a discharging sinus on the chest wall [9]. The revised WHO guidelines for the treatment of TB in children recommend that osteoarticular TB should be treated with a fourdrug regimen (rifampin, isoniazid, pyrazinamide and ethambutol) for 2 months followed by a 2-drug regimen (isoniazid and rifampin) for 10 months [10].…”

Section: Discussionmentioning

confidence: 99%

An unusual combination of extrapulmonary manifestations of tuberculosis in a child

Al-Otaibi

Almuneef

Hameed

2012

Journal of Infection and Public Health

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We report the case of a 10-year-old girl who presented to the emergency department with acute abdominal pain. She was diagnosed as having extrapulmonary tuberculosis (TB) with multifocal osteomyelitis of the spine and ribs, peritonitis and intestinal involvement. We describe the clinical presentation of this unusual constellation of the disease in the absence of pulmonary involvement in a child and discuss the diagnostic challenges and treatment of these rare forms of TB.

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“…Uncomplicated tuberculous bone lesions may resolve under medical therapy which according to some investigators must be given for a prolonged period lasting upto 1 year 17. Surgical excision with primary closure is recommended for patients who fail to improve after 3–4 weeks of ATT or under conditions, such as unstable or deformed bone structure, bearing a high risk of sinus formation.…”

Section: Discussionmentioning

confidence: 99%