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[Extrapulmonary and extraspinal presentation of osteoarticular tuberculosis].

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[Extrapulmonary and extraspinal presentation of osteoarticular tuberculosis].

Acta Ortop Mex. 2012 Jan-Feb;26(1):15-20

Authors: Aparicio G, Viudez I, Pérez JL, Delgado F

Abstract
BACKGROUND: How to overcome the difficulty in diagnosing extrapulmonary and extraspinal osteoarticular tuberculosis? What is the most appropriate way to manage the patient?
MATERIAL AND METHODS: Retrospective series of four cases of extrapulmonary and extraspinal osteoarticular tuberculosis (two patients with knee involvement, one patient with involvement of the carpus, and a fourth patient who presented with tenosynovitis of the anterior tibial tendon of the ankle). The time elapsed from the onset of the clinical picture to the diagnosis ranged between 7 months and 2 years. The definitive diagnosis resulted from the presence of caseating granulomas in the biopsy (3 cases), and the isolation of the bacillus in culture (3 cases) or with staining (one case). Only in one case was there lung involvement after the extrapulmonary presentation. One patient had spinal involvement in the form of epidural abscess months after the extraspinal presentation. All patients received chemotherapy. Surgery was performed in 3 of the 4 cases. The Martini assessment was used to evaluate the functional outcome.
RESULTS: In all patients the lesion was cured, with two excellent and two poor functional outcomes.
CONCLUSIONS: A high clinical suspicion index is needed to prevent a delayed diagnosis. Chemotherapy is the cornerstone of treatment. Surgery is indicated mainly as a diagnostic procedure, but partial resection of the lesion may be performed at the same time.

PMID: 23320335 [PubMed – indexed for MEDLINE]

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