-

Öz

Tuberculosis trochanteric bursitis accounts for around only %1 of all cases of musculoskeletal tuberculosis andmusculoskeletal tuberculosis is about %10 of extrapulmonary tuberculosis. Tuberculosis trochanteric bursitis associatedwith chronic nonspecific findings, such as local tenderness, swelling, pain. Differential diagnosis is difficult because ofnonspecific findings in plain radiographs and computed tomography. Inflammatory findings are determined in magneticresonance and scintigraphy. Definitive diagnosis is confirmed with biopsy, acid-fast staining and culture. Rice bodiescan see. Lymphocytes, histiocytes, plasma cells, langerhans cells with caseous necrosis in granulomatous inflammatorytissue are presented in histopathology. Surgical resection, debridement, irrigation and anti-tuberculosis drugs use intreatment. A 30 years old female patient was treated surgically due to trochanteric bursitis in another clinic last year.The patient was admitted to our clinic due to recurrence of the symptoms. Rice bodies had seen in surgery period in ourclinic. The patient received antituberculosis therapy for 10 months, after which complete remission was obtained

Anahtar Kelimeler

• Tuberculosis bursitis; trochanteric; rice body

Tüberküloz Trokanterik Bursit: Bir Olgu Sunumu

Öz

Akciğer dışı tüberkülozun %10’u kas iskelet sistemini tutarken, tüberküloz trokanterik bursit kas iskelet sistemi tüberkülozlarının sadece %1’ini oluşturmaktadır. Tüberküloz trokanterik bursit lokal hassasiyet, şişlik, ağrı gibi kronik nonspesifik bulgularla gelir. Düz grafi ve bilgisayarlı tomografi nonspesifik bulgular verdiğinden ayırıcı tanı güçtür. Manyetik rezonans ve sintigrafide enflamatuar bulgular saptanır. Biyopsi, mikobakterium kültürü ve aside dirençli boyama ile kesin tanı konur. Pirinç taneciği cisimcikleri görülebilir. Histopatolojide kazeifikasyon nekrozu olan granülomatöz enflamatuar doku ile birlikte lenfositler, histiyositler, plazma hücreleri, langerhans hücreleri görülür. Tedavi trokanterik bursanın cerrahi rezeksiyonu, debritman, irrigasyon ile birlikte antitüberküloz tedavidir. 30 yaşında trokanterik bursit nedeniyle daha önce başka bir klinikte cerrahi tedavi uygulanmış tekrarlayan trokanter bursiti olan bayan hastanın 4 yıl önce geçirilmiş pulmoner tüberküloz öyküsü mevcuttu. Hastanın cerrahi tedavisi sırasında trokanterik bursa içinde çok sayıda pirinç taneciği cisimciği görüldü. Hastaya 10 ay antitüberküloz tedavi uygulandı ve tedavi sonunda tam iyileşme sağlandı.

Anahtar Kelimeler

• Tüberküloz bursit; trokanter; pirinç taneciği cisimciği

Kaynakça

1. Martinez SF, Canale ST. Tuberculosis and other unusual infections. In: Canale ST, editor. Campbells operative orthopaedics. Vol 1. 10th ed. St Louis, London, Philedelphia, Sydney, Toronto: Mosby; 2003. p.713-23.
2. Kılıçarslan Z. Dünyada ve Türkiye’de Tüberküloz, Antibiyotik ve Kemoterapi Derneği Derg. 2007; 21(Ek 2): 76-80.
3. Lee SH, Abramson SB. Infections of the musculoskeletal system by M. tuberculosis. In: Rom WN, Garay SM, editors. Tuberculosis. New York, NY: Little, Brown and Company; 1996. p. 635-44.
4. Watts HG, Lifso RM. Current concepts review: tuberculosis of bones and joints. J Bone Joint Surg Am. 1996; 78(2): 288-98.
5. Crespo M, Pigrau C, Flores X, Almirante B, Falco V, Vidal R, et al. Tuberculous Trochanteric Bursitis: Report of 5 Cases and Literature Review. Scand J Infect Dis. 2004; 36(8): 552-8.
6. Hoffman KL, Bergman AG, Hoffman DK, Harris DP. Tuberculous tenosynovitis of the flexor tendons of the wrist: MR imaging with pathologic correlation. Skeletal Radiol. 1996; 25(2): 186-8.
7. Yamamoto T, Iwasaki Y, Kurosaka M. Tuberculosis of the greater trochanteric bursa occurring 51 years after tuberculous nephritis. Clin Rheumatol. 2002; 21(5): 397-400.
8. Ihara K, Toyoda K, Ofuji A, Kawai S. Tuberculous bursitis of the greater trochanter. J Orthop Sci. 1998; 3(2): 120-4.

9. Lynch AF. Tuberculosis of the greater trochanter: A report of eight cases. J Bone Joint Surg Br. 1982; 64(2): 185-8.
10. Lee SH, Abramson SB. Infections of the musculoskeletal system by M. tuberculosis. In: Rom WN, Garay SM, editors. Tuberculosis. New York: Little, Brown and Company; 1996. p. 635-44.
11. Sawlani V, Chandra T, Mishra RN, Aggarval A, Jain UK, Gujral RB. MRI features of tuberculosis of peripheral joints. Clin Radiol. 2003; 58(10): 755-62.
12. Wongworawat MD, Holtom P, Learch TJ, Fedenko A, Stevanovic MV. A prolonged case of Mycobacterium marinum flexor tenosynovitis: radiographic and histological correlation, and review of the literature. Skeletal Radiol. 2003; 32(9): 542-5.
13. Akman Ş, Yanoğlu AS, Aksoy B, Kavuk F, Öztürk İ. Omuzda yumuşak doku kitlesi ile kendini gösteren ve pirinç taneleri (rice body) içeren subakromial bursit olgusu. Acta Orthop Traumatol Turc. 2000; 34(5): 528- 31.
14. Yüksel HY, Akşahin E, Çelebi L, Muratlı HH, Biçimoğlu A. İzole büyük trokanter tüberkülozu: Olgu sunumu. Joint Diseases and Related Surgery. 2006; 17(3): 151-4.
15. Steinfeld R, Rock MG, Younge DA, Cofield RH. Massive subacromial bursitis with rice bodies. Report of three cases, one of which was bilateral. Clin Orthop. 1994; 301(1): 185-90.
16. McCarty DJ. Synovial fluid. In: McCarty DJ, editor. Arthritis and Allied Conditions A Textbook of Rheumatology. Philadelphia: Lea & Febiger; 1989. p. 84.
17. Aşık M, Altınel L, Dikici F, Temelli Y. Diz ekleminde sinovya kaynaklı pirinç tanesi (rice bodies) cisimcikleri. Acta Orthop Traumatol Turc. 2000; 34(3): 312-5.
18. Huston KA, Nelson AM, Hunder GG. Shoulder swelling in rheumatoid arthritis secondary to subacromial bursitis. Arthritis Rheum. 1978: 21(1): 145.
19. Wynne-Roberts CR, Cassidy JT. Juvenile rheumatoid arthritis with rice bodies: Light and electron microscopic studies. Ann Rheum Dis. 1979; 38(1): 8.
20. Pimm LH, Waugh W. Tuberculous tenosynovitis. J Bone Joint Surg. 1957; 39-B(1): 91-101.
21. Bush DC, Schneider LH. Tuberculosis of the hand and wrist. J Hand Surg. 1984; 9(3): 391-8.
22. Klofkorn RW, Steigerwald JC. Carpal tunnel syndrome as the initial manifestation of tuberculosis. Am J Med. 1976; 60(4): 583-6.
23. Tuncay İ, Tosun N, Uğraş S, İnce Ö. Artroplasti- artroskopik cerrahi. Journal of arthroplasty and arthroscopic surgery. 2002; 13(2): 108-10.