PUBIC TUBERCULOUS OSTEOARTHRITIS - 2 CASE S

Objective The authors report an exceptionnal site of tuberculous osteo -articular infection which must be diagnosed before the destructive st age. Observations Case I: a 21 years old woman presented an inflammato ry pubic pain after a trauma with wheight loss of 4 kgs in 3 weeks, Sh e presented also 2 satellite inguinal nodes. Erythrocyte sedimentation rate (ESR) was elevated, X-rays showed an important osteolysis of the left ischio-pubic rami, tuberculous skin test (TST) was positive, myc obacterium tuberculosis (MT) could not be found neither in sputtum nor in urine but the node biopsy showed the specific features of tubercul osis Evolution under a 6 months antibiotic treatment was good. Case 2: a 19 years old woman, with history of tuberculous contagion, presente d in April 1996 cervical nodes and a month later inflammatory pubic an d knee pain with wheight loss and vesperal sudation. ESR was elevated, TST was phlyctenular, MT searching and HIV serology were negative. X rays showed irregular osteolysis of the pubic symphysis, Scintigraphy showed an increased fixation of pubis and left knee, Cervical nodes bi opsy diagnosed tuberculosis. Evolution was good under a 6 months antib iotic treatment. Discussion Many factors can favorize the development of a pubic tuberculosis and are similar for all forms of tuberculous o steo-articular infection (trauma and contagion in our cases). Radiolog ical features, characterized by a slow evolution, are note specific, D iagnostic confirmation must be bacteriologic or pathologic, and if pos sible far from the pubic foci. Any traumatic medical procedure has to be avoided because of painful outcome and local risk. Evolution under specific treatment, even of short course (6 months), is sufficient for a good outcome. Conclusion One must think to pubic tuberculous osteo- arthritis in any pubic pain even if It is post-traumatic especially, i n endemic countries of tuberculosis.