Tuberculous osteomyelitis in the ulna of a patient undergoing hemodialysis

Intern Med. 2013;52(1):135-9. doi: 10.2169/internalmedicine.52.8437. Epub 2013 Jan 1.

Abstract

A 76-year-old woman on hemodialysis (HD) presented with pain and swelling in the left wrist and forearm. The osteomyelitis occurred in the part of the ulna adjacent to the arteriovenous fistula. Mycobacterium tuberculosis was identified in pus obtained from the left forearm, leading to a diagnosis of tuberculous osteomyelitis. The patient was treated with anti-tuberculous drugs and her symptoms improved. In this study, we report a case of tuberculous osteomyelitis occurring in the ulna, which is not the usual site of predilection for tuberculosis infection. As HD patients exhibit a high frequency of extrapulmonary tuberculosis, tuberculous osteomyelitis should be considered in the differential diagnosis of infectious osteomyelitis. In addition, it may be useful to perform stab cultures at an early stage in order to diagnose tuberculous osteomyelitis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Antitubercular Agents / therapeutic use*
  • Combined Modality Therapy / methods
  • Curettage / methods
  • Diffusion Magnetic Resonance Imaging / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / therapy
  • Mycobacterium tuberculosis / isolation & purification
  • Osteomyelitis / diagnosis
  • Osteomyelitis / microbiology*
  • Osteomyelitis / therapy
  • Radiography
  • Renal Dialysis / methods*
  • Risk Assessment
  • Treatment Outcome
  • Tuberculosis, Osteoarticular / diagnosis*
  • Tuberculosis, Osteoarticular / therapy
  • Ulna / diagnostic imaging
  • Ulna / surgery*

Substances

  • Antitubercular Agents