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1/342. Tuberculosis of the ankle: report of four cases.

    Tuberculosis of the ankle joint is relatively uncommon, and the treatment usually includes chemotherapy, immobilization and non-weight bearing protection. It is easily confused with pyogenic arthritis, which often leads to delayed diagnosis. We reviewed the records of 4 patients with ankle tuberculosis with advanced articular lesions without evidence of pulmonary tuberculosis. They took antituberculous agents for 5 to 6 months. Two of them had positive bacterial cultures, and all four had initially received surgical management under the impression of pyogenic osteomyelitis. Two patients underwent arthrodesis and the other two synovectomy with debridement. The clinical and radiologic results were better in the patients who underwent arthrodesis. We consider surgery with open biopsy of a painful swelling ankle to be helpful in the differential diagnosis of tuberculous and pyogenic arthritis. arthrodesis in patients with severe osteoarticular destruction of the ankle provides a better prognosis and more stable joint than other treatment methods. ( info)

2/342. Calvarial tuberculosis.

    We report a six-year-old boy who presented with swelling of the forehead, and had calvarial tuberculosis, a rare form of tuberculous osteitis. ( info)

3/342. Disseminated tuberculosis: still a diagnostic challenge.

    Disseminated tuberculosis is notoriously difficult to diagnose and, with the decrease in tuberculosis incidence in australia, familiarity with its manifestations has dwindled. We describe four bacteriologically proven cases which illustrate the range of presentations and diagnostic difficulties. Surprisingly, immunosuppressive therapy need not cause rapid deterioration. Disseminated tuberculosis should be considered in any patient with multisystem illness who is at risk of tuberculosis, particularly if born overseas. In the absence of confirmatory results, a prompt therapeutic trial may be life-saving. ( info)

4/342. Disseminated tuberculosis with gradual evolution and unusual localization.

    We present a case of disseminated tuberculosis (pulmonary, skeletal and lymph nodes) accompanied by subcutaneous abscesses and with unusual localization, osteolytic lesions of the skull caused by mycobacterium tuberculosis var. hominis. Although the patient was immunocompetent, the disease had a gradual and unexpected progression. In the malign forms of tuberculosis, treatment must be extended for a year or more. ( info)

5/342. Multifocal bone tuberculosis presenting as a breast mass: CT and MRI findings.

    Chest wall involvement is an uncommon manifestation of musculoskeletal tuberculosis. We present computed tomography and magnetic resonance imaging findings in a case with multifocal musculoskeletal tuberculosis presenting as a breast mass. These radiological modalities are not diagnostic without histopathological confirmation, but they are valuable guides to surgery in defining the extent of disease involvement. ( info)

6/342. Tuberculous orchitis co-existing with tuberculosis of the sternum--case report.

    The sternum and testis are infrequent localisations for extra pulmonary tuberculosis. The initial response to a co-existing lesion, as this case depicted is, to implicate a malignant process of some sort. A high index of suspicion is needed to overcome this diagnostic riddle. biopsy of the lesion and bacteriological work-up are essential ingredients of management. ( info)

7/342. Tuberculous osteitis of the cranium: a case report.

    A 3-year old male presented with a 12-month history of painless scalp swellings associated with cough, fever and night sweats. physical examination showed tender, fluctuant, pulsatile right frontotemporal and temporoparietal masses. skull radiographs showed osteolytic skull lesions in the frontal and temporal bones. microscopy of drained caseous material and histology of biopsies from the affected bone edges confirmed tuberculous osteitis. Though there was an initial response to antituberculous agents, the child died after 5 weeks from hepatic failure. Tuberculosis of the skull bones though rare, may become more common with the recent upsurge of tuberculosis worldwide. A high index of suspicion is necessary for early diagnosis and treatment. ( info)

8/342. Calvarial tuberculosis.

    OBJECTIVE: Tuberculosis is endemic in developing countries. However, calvarial tuberculosis is rare and only a few cases have been reported. In a review of the literature, we found only six cases of calvarial tuberculosis reported with computed tomographic findings. We report a series of seven patients with calvarial tuberculosis, and we discuss their presentations and treatments. methods: The patients were studied with respect to age and sex prevalences, previous histories of trauma and tuberculosis, and presenting complaints. Plain cranial x-ray films and computed tomographic scans were used for diagnoses. All patients underwent surgery and antituberculous chemotherapy. RESULTS: Of the presenting patients, 71.42% were less than 20 years of age. There was a female predominance, with a male/female ratio of 1:6. Painless swelling and discharging sinuses over the scalp were the most common presenting features. One patient presented with osteomyelitis and sinus formation, with associated meningitis. All patients recovered well after surgery and antituberculous chemotherapy, except for one patient who discontinued drug treatment. CONCLUSION: Although calvarial tuberculosis is rare, the possibility of this disease should be considered when patients report previous histories of tuberculosis or are from areas in which the disease is endemic. Surgery is indicated in cases with associated neurological deficits or sinus formation. Antituberculous therapy should be continued for 18 months. ( info)

9/342. CT findings in tuberculous otomastoiditis. A case report.

    PURPOSE: Otomastoiditis is a rare but important manifestation of tuberculosis and is well recognizable when information on its clinical course is considered in connection with the radiographic changes. MATERIAL AND METHOD: A patient with a clinical history of chronic otorrhea, resistant to conventional therapy but without dramatic symptoms, was referred for CT examination. RESULTS: CT revealed widespread soft tissue densities in the tympanic cavity and in the mastoid process, with bone erosions in the latter. Surgery and bacteriology confirmed the diagnosis of mycobacterium tuberculosis infection. CONCLUSION: CT evidence of widespread bone destruction without clinical signs of aggressive infection should suggest the diagnosis of a mycobacterial process. Early treatment is essential in order to avoid propagation of the disease and lasting loss of function. ( info)

10/342. Tuberculous arthritis of the knee--an unusual presentation.

    A 54 year old male who had an unusual clinical manifestation and radiological features proven to have tuberculosis arthritis of the knee on synovial biopsy is presented here. ( info)
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