Crohn disease or intestinal fistulising tuberculosis? Diagnosis difficulties in a case treated with infliximab and corticosteroids.
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Crohn disease represents an idiopathic inflammatory bowel disorder with possibility of local and extra intestinal complications. Infliximab therapy is one of major therapeutic alternatives but this treatment may by followed by several possible infections, especially the reactivation of a latent tuberculosis. We present a case of a 28-year-old patient who was admitted in our hospital with clinical signs of bowel obstruction. Colonoscopy revealed close stenosis al the level of splenic flexure. Surgery was soon performed for the imminence of occlusion and pathology has revealed chronic inflammatory infiltrate with lymphocytes and plasma cells, interpreted as Crohn disease complicated with stenosis. A treatment with prednisone 30 mg/day, ciprofloxacin 1000 mg/day administrated intermittently and sulphasalasine 3 g/day for one year was indicated but the patient develop external abdominal fistula. Infliximab therapy 5 mg/kg/dose was administered at two weeks interval, with initial good results after two doses. At two weeks after the second dose, the patient has presented fever and weight loss; abdominal CT-scan has revealed inflammatory adherences of right flexure of the colon with external fistula, resolved by surgery. The evolution was later complicated by right tibio-tarsian involvement, which imposed orthopedic intervention. Pathology has revealed bone tuberculosis and antibacillary therapy was initiated with good results. CONCLUSIONS: Bone tuberculosis may represent a rare evolutive modality at a patient with Crohn disease treated by Infliximab and corticoids. Infliximab therapy in a patient with immunosuppressant (previous corticotherapy, splenectomy) may activate a latent center of tuberculosis. Ciprofloxacin therapy may explain insidious modality of evolution by minor antibacillary effect. (+info)
Primary tubercular osteomyelitis of the sternum.
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Primary diaphyseal tuberculosis of the tibia.
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Tuberculous osteomyelitis involving primarily the diaphysis without articular involvement is very rare. Pain and swelling are the common presenting symptoms. The nonspecific nature of the symptoms leads to a delay in the diagnosis. Radiographs may mimic pyogenic osteomyelitis, Brodie's abscess, tumours or granulomatous lesions. Curettage of the lesion and the histopathological examination of the material obtained are necessary for confirmation of the diagnosis and offer a chance for early healing. We report the successful diagnosis and management of a rare case in a 28-year-old man of Indian origin afflicted with primary diaphyseal tuberculosis of the left tibia. (+info)
Total hip arthroplasty in patients with active tuberculosis of the hip with advanced arthritis.
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Osteoarticular tuberculosis--diagnostic solutions in a disease endemic region.
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BACKGROUND: We conducted a study of osteoarticular tuberculosis in patients from private and public settings in a disease endemic area. Our objective was to assess the role of mycobacterial culture and polymerase chain reaction (PCR) in the diagnosis of osteoarticular tuberculosis (TB) in settings where only clinical and imaging diagnosis form the basis for treatment. METHODOLOGY: Ninety-three consecutive specimens collected from clinically suspected patients of osteoarticular TB were screened for bacterial culture, mycobacterial culture and in-house nested PCR. In addition, specimens were examined by imaging and histopathology. Ten specimens collected from patients suffering from other bone diseases were included as negative controls. RESULTS: Of the 93 clinically suspected TB patients, mycobacterial culture was positive for Mycobacterium tuberculosis (MTB) in 47 (51%) patients who were confirmed as definite TB cases. Of the remaining patients, 16 (17%) were diagnosed as probable, 19 (20%) as possible, and 11 (12%) as only clinically suspected TB cases. In-house nested PCR was positive in 65 (70%) cases. Fifteen patients were resistant to one or more anti-tuberculous drugs; twelve patients were multi-drug resistant, two of whom were extensively drug resistant. CONCLUSION: Mycobacterial cultures using liquid media with susceptibility should form the backbone of management of osteoarticular TB. Nested PCR enhances the sensitivity if performed in addition to culture. (+info)