Tuberculose claviculaire révélée par une lacune osseuse

Abstract

Our study reports the case of a 30 years old woman, Mrs. S.S, with no particular past medical history. The anamnesis revealed an occasional consumption of not pasteurized dairy products. She was examined after the fortuitous discovery of a swelling in her right clavicular region, with no associated general symptoms. Physical exam revealed a mass measuring 4 cm (long axis) of hard consistency, painless, without inflammatory signs and fixed to deep plane. The remaining elements in somatic examination were normal. Biology was without abnormalities. Tuberculin intradermal reaction (IDR) was phlyctenular. Standard radiographic evaluation of the shoulder showed a bone gap of the distal edge of the right clavicle. MRI revealed anterior-superior cortical-medullary osteolysis of the right clavicle with irregular aspect, erosion and thinning of the adjacent cortical bone sparing the acromioclavicular joint and predominantly anterior inflammation of periosseous soft tissues (Figure A). Bone biopsy showed multiple follicular lesions composed of epithelioid cells and giant cells surrounding wide ranges of caseous necrosis. The thoraco-abdominopelvic CT and bone scintigraphy showed no other alterations. The diagnosis of isolated clavicular tuberculosis was retained. The patient underwent quadruple antituberculosis treatment (isoniazid, rifampicin, ethambutol and pyrazinamide) for two months and then a combination therapy (isoniazid and rifampicin) for a total treatment duration of 9 months. Clinical and radiological outcome was favorable. The patient underwent 18-month follow-up.

Pan African Medical Journal 2016; 24