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Lumps and bumps

Penelope Ann Bryant1, Delane V Shingadia

  • 1Great Ormond Street Hospital, Infectious Diseases, Great Ormond Street, London WC1N 3JH, UK.

BMJ Case Reports
|August 11, 2011
PubMed

Insights

A child with skin lumps and tibial osteomyelitis was diagnosed with tuberculosis after initial treatments failed. Prompt antituberculous therapy led to improvement in skin lesions, highlighting the importance of considering tuberculosis in endemic cases.

Area of Science:

  • Pediatric Infectious Diseases
  • Dermatology
  • Orthopedic Surgery

Background:

  • Disseminated tuberculosis can present with unusual cutaneous manifestations.
  • Osteomyelitis is a rare but serious complication of tuberculosis, particularly in children.

Purpose of the Study:

  • To report a case of a child with multifocal cutaneous lumps and tibial osteomyelitis caused by Mycobacterium tuberculosis.
  • To emphasize the diagnostic challenges and treatment approach for disseminated tuberculosis in a pediatric patient with a history of travel to an endemic area.

Main Methods:

  • Clinical presentation of an 8-year-old boy with multiple cutaneous lumps and bone erosion.
  • Diagnostic workup including imaging (ultrasound, CT scan), biopsy, and microbiological tests (Ziehl-Neilsen, Gram stain, TST, Quantiferon).
  • Identification of Mycobacterium tuberculosis from pus aspirate.

Main Results:

  • Cutaneous lumps and tibial osteomyelitis were identified.
  • Standard antibiotics and antifungals were ineffective.
  • Mycobacterium tuberculosis was cultured, confirming tuberculosis.
  • The patient showed improvement in skin lesions after initiating quadruple antituberculous therapy.

Conclusions:

  • Disseminated tuberculosis should be considered in children presenting with unexplained cutaneous lesions and osteomyelitis, especially with a travel history to endemic regions.
  • Early diagnosis and appropriate antituberculous therapy are crucial for managing this condition.
  • Long-term monitoring is necessary to assess the outcome of osteomyelitis.

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