Tuberculous Osteomyelitis of The Pubic Symphysis - a Case Report of a Rare Entity Mimicking Spondyloarthritis.

IF 1.4 4区 医学 Q3 RHEUMATOLOGY ARP Rheumatology Pub Date : 2023-01-01
Filipe Oliveira Pinheiro, Pedro Madureira, Maria Seabra Rato, Lúcia Costa
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Abstract

Tuberculosis (TB) osteomyelitis of the pubic symphysis is an extremely rare diagnosis. Axial spondyloarthritis (SpA) is characterized by inflammatory back pain and enthesitis, and involvement of pubic symphysis is very unusual at presentation. A 36-year-old female patient with a history of inflammatory back and pubic pain was referred to Rheumatology. She had a pelvic magnetic resonance imaging (MRI) suggestive of osteitis pubis. She was started on etoricoxib 90mg/day as axial spondyloarthritis was suspected, with no improvement. Pelvic MRI was repeated and showed osteomyelitis of the iliopubic branches. An ultrasound-guided biopsy was performed, and culture was positive for Mycobacterium tuberculosis. Further imaging studies revealed small cavitations and several centrilobular micronodules with a tree-in-bud pattern in the upper lung lobes and in the upper segment of the lower left lobe. She was started on anti-tuberculous treatment for 1 year and had a good clinical and radiological response. TB osteomyelitis of the pubic symphysis is a rare entity and has seldom been reported. However, this is the first case, to our knowledge, where the clinical picture mimicked an itself unusual presentation of SpA.

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耻骨联合结核性骨髓炎-一罕见的模拟脊柱炎的病例报告。
耻骨联合的结核性骨髓炎是一种极为罕见的诊断。轴性脊柱炎(SpA)的特征是炎症性背痛和全身炎,在表现时累及耻骨联合是非常罕见的。一位36岁女性患者,有背部炎症和耻骨疼痛史,被转介至风湿病科。她有盆腔磁共振成像(MRI)提示耻骨炎。她开始服用依托妥昔布90mg/天,因为怀疑是轴性脊柱炎,没有改善。骨盆MRI复查显示髂耻骨支骨髓炎。超声引导下活检,结核分枝杆菌培养阳性。进一步的影像学检查显示肺上叶和左下叶上段有小空洞和几个小叶中心微结节,呈树状芽状。患者开始抗结核治疗1年,临床和放射学反应良好。耻骨联合结核骨髓炎是一种罕见的实体,很少被报道。然而,据我们所知,这是第一例临床图片模仿自身不寻常的SpA表现。
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