Particularités des infections ostéo-articulaires tuberculeuses

Abstract

Bone, articular or spinal tuberculosis is rare (200 to 300 cases per year in France) but should not be forgotten, in particular in patients with an osteoarticular infection, with negative initial bacteriology. The risk of tuberculosis is higher in foreign patients, immunosuppressed, homeless, prisoners or people living in precarious conditions. The destructive bone involvement of tuberculosis can mimic tumor pathology, emphasizing the importance of quality histological analysis, in front of a solid or multifocal lytic image. Tuberculous monoarthritis, subacute or chronic, looks like the onset of inflammatory rheumatism, justifying the performance, in the slightest doubt, of a synovial biopsy. The possibility of performing a PCR, from bone, joint or spinal samples, saves time for the initiation of a complex antibiotic therapy, which is effective but source of potentially serious side effects. Methodical, close, clinical, radiographic and biological monitoring is essential to support the patient for 6 to 9 months.