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Musculoskeletal Tuberculosis

Musculoskeletal Tuberculosis. William Kwan UNC Internal Medicine-Pediatrics. Pott ’ s Disease. In endemic countries, usually affects children and young adults In developed countries, often disease of older adults 20% of tuberculous infections are extrapulmonary

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Musculoskeletal Tuberculosis

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  1. Musculoskeletal Tuberculosis William Kwan UNC Internal Medicine-Pediatrics

  2. Pott’s Disease • In endemic countries, usually affects children and young adults • In developed countries, often disease of older adults • 20% of tuberculous infections are extrapulmonary • 1-5% of tuberculous infections involve the musculoskeletal system • Involves thoracic spine in 50% • Paraspinal abscesses develop in about half of all cases • Pus can remain confined by ligaments and dissect along tissue planes up to supraclavicular space and even down to posterior iliac crest, groin, popliteal fossa

  3. Pott’s Disease • Should be suspected in patients with a history of treated/untreated TB and new back pain • May present with back pain solely without evidence of other tuberculous foci or systemic signs • If sinus formation, stains and cultures of pus positive for mycobacterium only half of the time AND secondary infections by other bacteria may also occur • Variable ESR

  4. Pott’s Disease • X-rays may show irregular cavities and bony destruction without surrounding sclerosis • Usually involves anterior end plates, resulting in herniation of intervertebral disks and “step-off” kyphosis • MRI may show paravertebral abscesses without bony involvement • CT best for looking for bony destruction • MRI best for looking for myelopathy or nerve compression

  5. Extra-axial Tuberculosis • Tuberculous arthritis and bursitis known to occur • Usually involves a single site, but multiple site involvement possible • Progressive pain and swelling without systemic symptoms • Phemister’s Triad: • Juxta-articular osteoporosis • Peripheral osseous erosions • Joint space narrowing • **Must biopsy and culture synovium and periarticularbone as culture of synovial fluid is often nondiagnostic

  6. Treatment • 6 to 9 months of INH and rifampin • 12 to 18 month regimens were suggested in the past • 1st 2 months should include ethambutol and pyrazinamide • Surgery may be indicated if no response to therapy, instability of spine, or neurologic deficits

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