结核病(TB)是由细菌结核分枝杆菌引起的具有潜在肺外表现的肺部疾病。尽管在治疗方面取得了进展,结核病仍然是全球公共卫生问题。结核病骨髓炎约占所有肺外结核病病例的3-5%。我们介绍了一例22个月大的女性肱骨结核骨髓炎,没有肺部或全身症状。此病例提供了对结核病骨髓炎的诊断和管理的见解。一名22个月大的先前健康的海地裔美国女性,在肱骨近端前外侧有一个月明显的肿块,没有覆盖红斑或软组织肿胀。没有报告其他症状。她最近没有生病的接触,但在婴儿期访问过海地。右肱骨近端X线和随后的MRI显示肱骨近端骨髓炎伴有骨内Brodie脓肿。切开和引流提取的干酪样材料,通过聚合酶链反应检测结核分枝杆菌呈阳性。通过阳性QuantiFERON-TB金和纯化的蛋白质衍生物测试确认了诊断。患者接受了左氧氟沙星治疗,异烟肼,吡嗪酰胺,吡哆醇,住院期间还有利福平.放电后,她继续接受抗生素治疗,并由佛罗里达卫生部管理。放电后,3个月和12个月的X射线显示病变愈合的证据。结核病骨髓炎是结核病感染的一种罕见表现,可能隐匿而无全身或肺部症状。及时治疗对预防并发症至关重要,病因不明的骨块应调查结核感染,即使没有其他症状。
Tuberculosis (TB) is a pulmonary disease with potential extrapulmonary manifestations that is caused by the bacteria Mycobacterium tuberculosis. Despite advancements in treatment, TB remains a worldwide public health concern. TB osteomyelitis accounts for approximately 3-5% of all extrapulmonary TB cases. We present a case of humeral TB osteomyelitis in a 22-month-old female with no pulmonary or systemic symptoms. This case offers insight into the diagnosis and management of TB osteomyelitis. A 22-month-old previously healthy Haitian-American female presented with a one-month history of a palpable mass over the anterolateral aspect of the proximal humerus without overlying erythema or soft tissue swelling. No additional symptoms were reported. She had no recent sick contacts but had visited Haiti during her infancy. Right proximal humerus X-ray and subsequent MRI revealed proximal humeral osteomyelitis with an intraosseous Brodie\'s abscess. Incision and drainage extracted caseous material, which tested positive for Mycobacterium tuberculosis via a polymerase chain reaction. The diagnosis was confirmed via positive QuantiFERON-TB Gold and purified protein derivative testing. The patient was treated with levofloxacin, isoniazid, pyrazinamide, pyridoxine, and rifampin during the hospitalization. Following discharge, she was continued on her antibiotic regimen and managed by the Florida Department of Health. Post-discharge, X-rays at three and twelve months showed evidence of lesion healing. TB osteomyelitis is a rare manifestation of TB infection, which may present insidiously without systemic or pulmonary symptoms. As timely treatment is vital to preventing complications, bone masses of unknown etiology should be investigated for TB infection, even without additional symptoms.