1 - Unidade de Infecciologia Pediátrica, Área de Pediatria, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
2 - Serviço de Imagiologia, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
3 - Unidade de Ortopedia, Área de Pediatria, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- 22º Congresso Nacional de Pediatria da Sociedade Portuguesa de Pediatria
- Publicação sob a forma de E-poster com discussão
Background: In children, bone and joint tuberculosis (TB) forms a small proportion of the total cases of tuberculosis. Systemic signs are commonly absent in early forms of disease. In non-endemic regions TB diagnosis is frequently delayed.
Case presentation summary: A previously healthy, female child, aged three, reports dorsal lateral soft lump of the left foot with ten months evolution. She had no fever, previous trauma, and she was able to walk without restrictions. She has arrived two weeks before from Angola, where she lived since she was three months old. Immunizations updated and included BCG. The lesion was soft and non-tender to touch, without local inflammatory signs, sized 2x3cm. MRI shown a cuboid lytic liquid filled lesion, fistulising to subcutaneous antero-lateral tarsus. Initial workup shown normal leucogram (5,54 x 10^9/L, neutrophils 1,54 x 10^9/L- 28%, lymphocytes 3,51^9/L- 63%), sedimentation rate (6mm/h), reactive protein C (0.2mg/L), negative IGRA and excluded HIV. The tuberculin sensitivity test was positive (15mm induration at 48h), thorax radiography and CT and abdominal ultrasound shown no lesions. She was admitted for surgical drainage and biopsy, she completed 17 days of flucloxacillin. Blood and bone conventional cultures were sterile. Lesion histology was compatible with necrotizing granulomatous inflammatory process, no agent identified by Ziel-Nielsen, Grocott's or PAS staining. TAAN was negative. Lowenstein-Jensen culture is still pending incubating. Assuming bone TB, although other mycobacteria cannot be excluded, she was started on antibacilar treatment with isoniazid (H) rifampicin (R), pyrazinamide (Z) and ethambutol (E).
Learning points: A high index of suspicion of bone-TB should be kept in children with “cold abscesses” especially in high-risk populations, to improve treatment response and reduce associated morbidity.
Palavras Chave: Osteomyelitis, TB, pediatric