Facundo E Stingo1,2,3, Francisco Rodriguez-Fontan3,4, Evalina Burger-Van der Walt4, Javier Arce1, Sebastian N Garcia1,3, Ricardo M Munafo1,5. 1. CETEA, Buenos Aires, Argentina. 2. Department of Medicine, MedStar Washington Hospital Center/Georgetown University Hospital, School of Medicine, Washington, DC. 3. Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina. 4. Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado. 5. Facultad de Medicina, Universidad de Ciencias Empresariales y Sociales, Buenos Aires, Argentina.
Abstract
CASE: Following an insidious onset of symptoms, a 29-year-old man who had no risk factors for tuberculosis was diagnosed with tuberculosis of the iliac crest. The red flag in this case was the patient's progressive deterioration despite a variety of antibiotic regimens. Histopathologic demonstration of necrotic granulomatous inflammation and a positive culture led to the diagnosis. A combination of surgery and antitubercular-drug therapy resulted in clinical recovery. CONCLUSION: Iliac crest tuberculosis represents <1% of all skeletal tuberculosis cases. Even in the absence of classic symptoms and risk factors, orthopaedic surgeons should maintain a low threshold for tuberculosis in the differential diagnosis.
CASE: Following an insidious onset of symptoms, a 29-year-old man who had no risk factors for tuberculosis was diagnosed with tuberculosis of the iliac crest. The red flag in this case was the patient's progressive deterioration despite a variety of antibiotic regimens. Histopathologic demonstration of necrotic granulomatous inflammation and a positive culture led to the diagnosis. A combination of surgery and antitubercular-drug therapy resulted in clinical recovery. CONCLUSION: Iliac crest tuberculosis represents <1% of all skeletal tuberculosis cases. Even in the absence of classic symptoms and risk factors, orthopaedic surgeons should maintain a low threshold for tuberculosis in the differential diagnosis.