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Disseminated Bone Tuberculosis (So-Called Multiple Cystic Tuberculosis)

1950; Radiological Society of North America; Volume: 55; Issue: 6 Linguagem: Inglês

10.1148/55.6.839

1527-1315

Gilbert H. Alexander, Matthew M. Mansuy,

Orthopedic Infections and Treatments

An attempt to review the literature, in connection with the case of disseminated bone tuberculosis to be described in this communication, showed a voluminous accumulation of papers regarding osteitis tuberculosa multiplex cystoides, based on the original report of Jüngling in 1920. According to Sweet and Abramson (7), the group of cases reported by Jüngling was characterized by the following features: most frequent involvement of the small bones of the hands and feet, a tendency to form cyst-like lesions without reactive changes, a negative tuberculin test, failure to show tubercle bacilli, absence of caseation, frequent coexistence of skin lesions (sarcoid), and spontaneous regression. The various cases subsequently reported as osteitis tuberculosa multiplex cystoides do not represent a homogeneous group. The designation has been applied to cases with all the criteria of Boeck's sarcoid as well as to those of proved tuberculous etiology. Ellis (1) in 1939 recognized this confusion. He pointed out that Jüngling's disease is osteal sarcoid; that it is pseudocystic in character rather than cystic; and that it is not cystic tuberculosis of bone. Monfort and Solomon (4) in 1942 reported a case as osteitis tuberculosa multiplex cystoides but called attention to the fact that this disease as seen in children differed in the following respects from Jüngling's cases: there was a greater tendency to involvement of the long hollow bones; associated cutaneous lesions were infrequent; the tuberculin test was usually positive: guinea-pig inoculations sometimes gave positive results; caseation was occasionally seen; there was a tendency for the lesions to heal locally, but frequently the patient died of generalized tuberculosis. They suggested that the disease in children represented an entity which is intermediate between Boeck's sarcoid and caseous tuberculosis of bone. Most of the cases with bacteriologic proof of a tuberculous etiology have been reported in the pediatric literature, and emphasis has been placed on involvement of the long bones. In contrast, our adult case showed involvement of the axial skeleton. This variance in the distribution of lesions is in accord with the different patterns in adults and children noted and discussed by Nathanson and Cohen (5). These writers reviewed 200 cases of proved bone and joint tuberculosis in 1940. Thirty-five per cent of their pediatric cases and 28 per cent of their adult cases showed involvement of more than one area. In the adult group, no lesions of the metacarpals or phalanges, which are so prominent in Jüngling's disease, were encountered. It is considered that practically all cases of bone tuberculosis represent hematogenous spread of the organism from its primary port of entry. The cases reported would appear to fall into two broad categories: one group with involvement of only one bone or adjacent bones, and a second group in which there is a more general disseminated spread.