[Osseous tuberculosis as a rare differential diagnosis of femoral head necrosis].
BACKGROUND
We report on a 60-year-old immunocompetent German male patient without risk factors, who had been suffering from pain in the right hip for 8 months.


METHODS
Radiographs showed destruction of the femoral head with a collapse of the main weight-bearing area, which was interpreted as femoral head necrosis.


METHODS
A cement-free total hip prosthesis was then implanted. The femoral head was sent for routine histological analysis and PCR amplification yielded a positive result for Mycobacterium tuberculosis complex DNA, leading to immediate guideline-based tuberculostatic treatment.


CONCLUSIONS
Tuberculosis should be considered as a differential diagnosis in the case of destruction of the femoral head, especially in immunocompromised patients, patients with a foreign background or destructive osteoarthritis of the hip with an atypical course. Antibiotic treatment is necessary postoperatively. Under this therapy, a good clinical outcome can be expected comparable to that achieved in patients with primary osteoarthritis without infection.
Sektion Hüft- und Beckenchirurgie, Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie und Klinik für Unfall- und Wiederherstellungschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
F
F
Scheel
M
M
Hufeland
B
B
Sinn
N P
NP
Haas
C
C
Perka
J H
JH
Schröder
D000995:Antitubercular Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005270:Femur Head / Q000473:pathology / Q000601:surgery; D005271:Femur Head Necrosis / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D035583:Rare Diseases; D014394:Tuberculosis, Osteoarticular / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery
D000995:Antitubercular Agents