Tuberculosis of the sternoclavicular joint.
نویسندگان
چکیده
PURPOSE To review the diagnosis and treatment of tuberculosis of the sternoclavicular joint in 13 patients. METHODS Records of 9 men and 4 women aged 26 to 47 (mean, 36.5) years who presented with tuberculosis of the right (n=8) or left (n=5) sternoclavicular joint were reviewed. RESULTS All 13 patients had a raised erythrocyte sedimentation rate at presentation. Nine patients presented with systemic symptoms including malaise, fever, or loss of weight/appetite. Local symptoms included cold abscess (n=5), tenderness and non-fluctuant swelling (n=4), and discharging sinus (n=4). The mean duration of symptoms was 2.7 (range, 1-7) months. Four patients had multifocal involvement of the proximal ulna (n=1), lung (n=2), and meninges (n=1). Aspiration (n=3), fine needle aspiration cytology (n=4), drainage (n=2), or curettage (n=4) of the swelling, abscess, or sinus was performed, and the diagnosis was confirmed by histopathology (n=8), polymerase chain reaction (n=5), or culture (n=1). Two patients were diagnosed based on clinical suspicion. 11 patients responded to antituberculous therapy (ATT), and symptoms resolved after 6 to 8 weeks. Two patients did not respond to ATT after 3 months and were screened for immunocompromising disorders or drug resistance. Their CD4 count and CD4:CD8 ratio was low, and an immunomodulation regimen was prescribed as an adjunct to ATT. CONCLUSION A high level of clinical suspicion is needed to diagnose tuberculosis of the sternoclavicular joint in patients with pain/tenderness, discharging sinus, or cold abscess. A combination of histopathological and microbiological tests, and PCR can confirm the diagnosis.
منابع مشابه
[Tuberculosis arthritis of the sternoclavicular joint].
Tuberculosis remains a public health problem in developing country particularly in Tunisia. Bone location of tuberculosis infection is increasing and is often misdiagnosed due to the weakness of clinical presentation in early stages. Sternoclavicular joint tuberculosis is rare and unusual location of this disease. However, antibiotherapy and surgical debridement is still the basis of treatment....
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عنوان ژورنال:
- Journal of orthopaedic surgery
دوره 23 3 شماره
صفحات -
تاریخ انتشار 2015