Turner syndrome with Tubercular Osteomyelitis of iliac bone – An Unusual Presentation

16 May


We read the article by Arvind Mogha et al. in march 2009 Isolated Left Ileum Bone Tuberculosis: A Case Report and Vivek TRIKHA et al Tuberculosis of the ilium: is it really so rare? With great interest .We recently encountered a similar complication in A 20 years old female having features of turner syndrome was admitted in Orthopedic ward with history of low grade fever off and on, severe pain in left iliac fossa and gradually increasing mass in left iliac fossa, and a discharging sinus over left groin for last 5 months. Discharge was thin purulent greenish in color.

Pain was so intense that she could neither sleep properly in spite of analgesics. There was no history of trauma. There was no history of anorexia, weight loss, backache, urinary or bowel complaints. On examination she was a febrile without any pallor. There was immobile, nontender, and soft to firm mass, about 5 x 5 cm size in left iliac fossa. On investigations her Hemoglobin was 10.2 gm%, ESR 62 mm fall at the end of first hour, X-rays chest was normal. X-ray lumbosacral spine revealed no abnormality. X-ray pelvis showed a well-defined, radiolucent defect in the left iliac crest about 1×1 cm in size (Fig- 1). Ultrasound abdomen and CT scan shows cystic mass about 5 x 5 cm in left iliac fossa. Incision and drainage of abscess was done in general anesthesia. It was found that abscess in the left iliac fossa abscess has got communication with the left gluteal region through defect in ala of left ilium. Histopathology of curetted piece of bone showed tuberculous osteomyelitis. With repeated dressings and antituberculous chemotherapy patient recovered within two months. On follow up the patient is doing well.

Tuberculosis remains the major source of morbidity and mortality worldwide, affecting approximately one-third of the world’s population. Osteoarticular involvement occurs in less than 3% of patients with extra pulmonary tuberculosis and of which spine represents half of this lesions1-2. Tuberculous osteomyelitis of the ilium is seen very rarely. Here we report a case of tubercular osteomyelitis of the isolated left ilium bone, proved on the basis of microbiological and histopathological examination of excisional biopsy specimen.
Tuberculosis of the ilium is a rare identity, and till now fewer cases are reported in literature.3 In a review of the literature we have been able to find reference to first case, that reported by Nelaton’ in 1892.4 The exact incidence of ilium bone tuberculosis is not known but it accounts for less than 1% of all skeletal tuberculosis 5.

Turners Syndrome is itself a rarity and combination of isolated iliac bone tuberculosis having discharging sinus with turners has never been reported.

Hip Bone, Indian Health journal, Iliac Bone

Fig 1: X-rays left hip bone showing a well defined radiolucent defect in iliac bone

“Conflict of interest: None.”

References

1. Bateman J. The Shoulder and Neck. WB Saunders Co. Philadelphia, 1975 (s)

2. Evan chick CC, Davis DE, Harrington TM: Tuberculosis of peripheral joints: an often missed diagnosis. Rheumatol 1986, 13:187-191

3 Ryan CA, Funston RV. Osteomyelitis of ilium (probably tuberculous): case report. J Bone Joint Surg Am. 1930; 12:165-167.

4 Babhulkar SS,Pande SK .Clinical orthopedics 2002 ;398:114-20 Unusual manifestation of osteoarticular tuberculosis. .

5 Trikha V, Varshney MK, Rastogi S. Tuberculosis of the ilium: is it really so rare. Acta Orthop Belg, 2005 ;71(3):366-8.
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About the Author:

Dr Ramji lal Sahu

Associate professor, Department Of Orthopaedics, SMS and RI, Sharda University.

Greater Noida, U. P., India

Contact:  Mobile no. 09871120703, Email drrlsahu@gmail.com

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