[Costosternal swelling and diffuse bone pain in tubercular osteomyelitis].
METHODS
For about a year a 28-year-old Nigerian had been suffering from diffuse bone pain, intermittent fever, weight loss and weakness. Physical examination was unremarkable except for a swelling at the sternal angle.


METHODS
The tuberculin test was clearly positive and tests for inflammatory disease were elevated, but the chest radiograph was normal. Bone scintigraphy demonstrated multiple sites of increased storage in the ribs and vertebral column. Magnetic resonance imaging revealed a large paravertebral abscess, which was needled under computed tomography monitoring. Polymerase chain reaction of the aspirate demonstrated Mycobacterium tuberculosis.


METHODS
While initial treatment with combined isoniazid, streptomycin, rifampicin and pyrazinamide, the first two drugs had to be discontinued, the microorganism not being sensitive to them, and were replaced by ethambutol and amikacin. The abscess was drained and the vertebral fracture surgically stabilised. There were no neurological abnormalities and the lesions largely healed.


CONCLUSIONS
Even without pulmonary involvement tuberculosis must be included in the differential diagnosis of rheumatic diseases with joint and vertebral column involvement, such as the SAPHO syndrome and other inflammatory bone diseases.
Hemmen
T
T
Abteilung für Allgemeine Innere Medizin, Universitätsklinikum Benjamin Franklin, Freien Universität Berlin.
Stölzel
U
U
Höffken
G
G
Vesper
J
J
Sieper
J
J
Distler
A
A
Braun
J
J
D000038:Abscess / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use; D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D004322:Drainage; D004359:Drug Therapy, Combination; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D010146:Pain / Q000209:etiology*; D016133:Polymerase Chain Reaction; D011859:Radiography; D011877:Radionuclide Imaging; D012272:Ribs; D016103:Spinal Fractures / Q000209:etiology / Q000601:surgery; D013131:Spine / Q000000981:diagnostic imaging; D013249:Sternum; D014374:Tuberculin Test; D014394:Tuberculosis, Osteoarticular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy
D000995:Antitubercular Agents