MULTIFOCAL BONE TUBERCULOSIS - A CASE-REP ORT

Introduction Tuberculosis of bone is rare (10 to 20 per cent of all sk eletal tuberculosis). The multifocal form is exceptionnal even in ende mic countries of tuberculosis. It constitues less than 5 per cent of a ll osseous tuberculosis.Case report O.H. 34 year-old, Moroccan woman o f black race not vaccinated against tuberculosis, with a contagion, co mplained for a year from scapular pain and weight loss. She noticed th at two masses had appeared six months ago. The patient was feverish (3 8 degrees). The physical exam showed a non inflammatory mass 10 cm wid e located in front of the left sacroiliac joint and seeming to be a co ld abscess. The radiologic assessment showed a lytic image of the hume rus upper extremity, the right iliopubis branch, the left ischium and the left iliac wing. The surgical biopsis of the humerus showed an evo lutive caseo-follicular tuberculosis. The nuclear scan of bone found t wo other localizations in the fourth lumbar vertebra and the ninth lef t rib. We conclued to a multifocal bone tuberculosis with seven locali zations The upper extremity of both humerus Right pubis Left ischium L eft iliac wing 4th lumbar vertebra 9th left rib. The treatment consist ed in a specific antibiotic therapy for 6 months associated to the eva cuation of the cold abcess. Discussion Multifocal bone tuberculosis is more frequent in young adults of black race. The beginning of the dis ease is progressive and the fistulas are the main reason of consultati on. The radiologic lesions are not specific and have a geodic shape ri mmed with an osteocondensation. Multifocal bone tuberculosis in black african predominate in flat bones. Otherwise in the white race it is l ocated in the long bones extremities. The diagnosis of certitude is ba sed on histologic findings of the peripheric bone lesion. The specific antibiotic therapy leads to the recovery if given early. Short protoc ols (9 or 6 months) are recently more used with success.