Tuberculous Osteomyelitis in the Ulna of a Patient Undergoing Hemodialysis

Nakazawa, Yuka; Nishino, Tomoya; Mori, Atsushi; Uramatsu, Tadashi; Obata, Yoko; Arai, Hideyuki; Hayashi, Hideyuki; Tsukasaki, Shoko; Muraya, Yoshiaki; Inoue, Yuichi; Yamamoto, Yoshihiro; Kohno, Shigeru

doi:10.2169/internalmedicine.52.8437

Cited by 4 publications

(4 citation statements)

References 26 publications

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“…It was found to be 6–25 times higher than in the general population, with mortality rates ranging from 17 to 75% [6]. Ates et al [8] reported that the median time between initiation of dialysis and diagnosis of TB was 11 months, which is consistent with several studies showing a high incidence of TB in the first year of dialysis attributable to poor health in general and compromised host immunity.…”

Section: Discussionsupporting

confidence: 58%

“…There are many known risk factors for TB infection, e.g., age, malnutrition, HIV infection, diabetes mellitus, transplantation, malignancy, and low socioeconomic status [5]. Advanced chronic kidney disease is also one of the risk factors due to impaired immune function secondary to oxidative stress and inflammation, 25-hydroxyvitamin D deficiency, malnutrition, anemia, and hyperparathyroidism [1, 6]. It seems clear that lymphopenia, suboptimal responses to mitogens, abnormal cytokine gene expression, and abnormal IL-2R expression are seen in a number of dialysis patients [7].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Uncommon Association of Tuberculous Dactylitis and Cutaneous Polyarteritis Nodosa in a Hemodialysis Patient

Yincharoen

Srisawat

2019

Case Rep Acute Med

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Tuberculous dactylitis, defined as the infection of the metacarpals, metatarsals, or phalanges of the hands or feet, is an uncommon manifestation of extrapulmonary tuberculosis. It is mainly seen in pediatric populations, especially those less than 6 years old. Here, we present a case of tuberculous dactylitis in an elderly patient with end-stage renal disease on hemodialysis. Moreover, our patient also developed generalized nodular lesions during hospitalization. Skin biopsy was consistent with cutaneous polyarteritis nodosa, which is a rare association with tuberculosis. She was treated with antituberculous drugs with significant improvement in both cutaneous nodules and dactylitic lesions.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Uncommon Association of Tuberculous Dactylitis and Cutaneous Polyarteritis Nodosa in a Hemodialysis Patient

Yincharoen

Srisawat

2019

Case Rep Acute Med

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“…Clinical presentations of extrapulmonary tuberculosis should be considered in the differential diagnosis of many infectious and noninfectious diseases (15). It can cause acute conditions such as meningitis and endocarditis, which have high morbidity and mortality rates, as well as infections with delayed diagnoses such as chronic osteomyelitis (16)(17)(18). In a study conducted in Turkey, tuberculosis was found to be the most common cause of infectious reasons for fever of unknown origin (19).…”

Section: Discussionmentioning

confidence: 99%

Applicability of Xpert MTB/RIF assay for routine diagnosis of tuberculosis: a four-year single-center experience

Çelik¹,

Gözel²,

Bakıcı³

et al. 2015

Turk J Med Sci

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The aim of this study is to assess the Xpert MTB/RIF assay for diagnosis of the Mycobacterium tuberculosis complex in clinical samples and to compare the results by reference to the diagnostic method, Bactec MGIT 960. Materials and methods:A total of 7407 samples were included from patients not primarily suggesting pulmonary or extrapulmonary tuberculosis (TB), collected from patients required to be screened for TB and excluding TB diagnoses since it was a differential diagnosis. Also included were a total of 411 samples from patients primarily suggesting pulmonary or extrapulmonary TB.Results: In the first group, 152 of 7407 samples yielded positive results with the Bactec MGIT 960, 131 (1.77%) were found positive with Löwenstein-Jensen medium, and 295 (3.99%) were found positive with Ziehl-Neelsen staining. In the second group, 24 (5.8%), 17 (4.1%), and 28 (6.8%) of 411 samples were found positive. Xpert MTB/RIF [27 (6.6%) of 411 samples] detected 3 additional samples as positive, and these 3 cases were clinically compatible with TB. Conclusion:The Xpert MTB/RIF assay shows superior performance for the diagnosis of TB. Its usefulness in culture-negative patients and the best method for integrating this diagnostic method into current tuberculosis diagnostic algorithms both need further study.

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“…The culture from the wound swab was regarded as a red herring. According to Nakazawa et al, 1 he and his team took 6 months to reach a diagnosis of tuberculous osteomyelitis reflecting the level of difficulty in differentiating tuberculous osteomyelitis from bacterial osteomyelitis or bone tumours. The mean interval between the first symptoms and the diagnosis was 26.4 months (range 1 month to 15 years).…”

Section: Discussionmentioning

confidence: 99%