Musculoskeletal Tuberculosis: New Insights on Diagnosis Strategy and Treatment

Elisa Chapuis, MD; Khadija Benali, MD, PhD; Olivia Silbermann-Hoffman, MD; Marie Berleur, MD; Sébastien Ottaviani, MD; Damien van Gysel, MD; Tiphaine Goulenok, MD; Thomas Papo, MD; Karim Sacre, MD, PhD

Disclosures

J Clin Rheumatol. 2022;28(4):201-205. 

In This Article

Abstract and Introduction

Abstract

Background/Objective: Skeletal tuberculosis (TB) is rare. We aimed to report on diagnostic strategy and treatment of skeletal TB.

Methods: In this multidisciplinary single-center medical records review study, all adult patients admitted between January 2009 and December 2019 with microbiologically proven skeletal TB were included. Demographic, medical history, laboratory, imaging, pathologic findings, treatment, and follow-up data were extracted from medical records.

Results: Among 184 patients identified with TB, 21 (16 women, 42 years [27, 48 years]) had skeletal involvement. Skeletal TB included spondylitis (n = 11), lytic bone lesions (n = 7), sacroiliitis (n = 5), arthritis (n = 3), osteitis (n = 2), and diffuse muscle abscesses without bone lesion (n = 1). Lytic lesions involved both axial and peripheral skeleton at multiple sites in most cases. 18F-fluorodeoxyglucose positron emission tomography was performed in 13 patients and helped to detect multifocal asymptomatic lesions and to target biopsy. All patients were treated with anti-TB therapy for 7 to 18 months. Fifteen patients (71.4%) received steroids as an adjunct therapy. Eleven patients needed an orthopedic immobilization corset, and 3 patients underwent surgery. All patients clinically improved under treatment, but 2 relapsed over a median follow-up of 24 months (12–30 months). No patient died or suffered long-term disabilities.

Conclusion: Our study emphasizes the diversity of skeletal involvement in TB. 18F-fluorodeoxyglucose positron emission tomography scanner at diagnosis is key to assess the extension of skeletal involvement and guide extraskeletal biopsy. Neurological complications might be prevented by adding corticosteroids to anti-TB therapy.

Introduction

In 2019, the World Health Organization reported 10 million new cases of tuberculosis (TB) and 1.4 million deaths from TB worldwide.[1] Even though TB is a curable and preventable disease, approximately a quarter of the world's population is infected with Mycobacterium tuberculosis. Musculoskeletal involvement is rare, reported in fewer than 5% of patients suffering from TB,[2,3] whereas autopsy studies identified bone lesions due to M. tuberculosis in up to 40% of patients,[4,5] suggesting that skeletal involvement might be overlooked. In the present study, we aimed to report on clinical features, diagnosis, and treatment strategies in musculoskeletal TB.

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