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Case Report: Multifocal Tubercular Osteomyelitis of the Spine and Bilateral Dactylitis

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  • 1 Institute of Clinical Infectious Disease, Catholic University of the Sacred Heart, Rome, Italy;
  • | 2 Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy;
  • | 3 Department of Radiological Sciences, Catholic University of the Sacred Heart, Rome, Italy;
  • | 4 Institute of Microbiology, Catholic University of the Sacred Heart, Rome, Italy
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We report a case of a 13-year-old immunocompetent male with multifocal tubercular osteomyelitis involving several spinal segments, small bones of the hands, and the scalp, who started with progressively back pain and enlarging painful swelling on the palms of hands, fatigue, and irregular fever. All the hand lesions were firm, mildly tender, and covered by ulcerated skin with serous discharge from the site. Magnetic resonance showed lesions of the right fifth metacarpal, of the right intermediate phalanx of the fourth finger, of the left second metacarpal, and of most vertebral bodies of the cervical, dorsal, lumbar, and sacral spine. The nucleic acid amplification test and the final culture from the drainage of the hands’ lesion were positive for Mycobacterium tuberculosis. The patient received a standard antitubercular treatment for 12 months with clinical improvement.

Author Notes

Address correspondence to Gianmaria Baldin, Catholic University of Sacred Heart, Largo Francesco Vito 1, Rome 00187, Italy. E-mail: gian.baldin@gmail.com

Disclosures: R. C. has been an advisor for Gilead, Janssen-Cilag and Basel Pharmaceutical; has received speakers’ honoraria from ViiV Healthcare, Bristol-Myers Squibb, Merck Sharp & Dohme, Abbott, Gilead and Janssen-Cilag; and has received research support from “Fondazione Roma.”

Authors’ addresses: Francesco Taccari, Gianmaria Baldin, Arianna Emiliozzi, Lara Campana, Enrica Tamburrini, Roberto Cauda, and Federico Pallavicini, Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy, E-mails: taccari@hotmail.it, gian.baldin@gmail.com, arianna11@hotmail.it, lara.campana@virgilio.it, enrica.tamburrini@unicatt.it, roberto.cauda@unicatt.it, and federico.pallavicini@unicatt.it. Edoardo Leone and Antonio Leone, Department of Radiological Sciences, Catholic University of the Sacred Heart, Rome, Italy, E-mails: edoleone.1989@gmail.com and antonio.leone1@unicatt.it. Giovanni Delogu and Michela Sali, Institute of Microbiology, Catholic University of the Sacred Heart, Rome, Italy, E-mails: giovanni.delogu@unicatt.it and michela.sali@unicatt.it.