The Tuberculosis Of A Child's Shoulder: A Report Of Two Cases

摘要

Introduction: The shoulder is an exceptional location for osteoarticular tuberculosis particularly in children. We are reporting two observations of male children's shoulder tuberculosis. Observation 1 :E.M.D., aged 14, was examined on June 28, 2001 for a three-week shoulder suppuration which was related to a trauma caused by a fall. The clinical examination revealed a 37.4° C temperature, a pain associated with a deformation of the shoulder and pus producing axillary fistula. The standard radiography showed lesions of osteoarthritis of the shoulder. The bacteriological examination of the pus was negative. Iterative arthrotomies and an antibiotherapy did not result in a healing. Intradermal tuberculin test was highlly positive. The shoulder's biopsy showed caseous necrosis and an epithelio-giganto-cellular follicle. The antituberculosis treatment, which just started 21 months after the beginning of the symptoms made the healing possible but at the cost of functional after-effects. Observation 2 :I. D, aged 10, was examined on April 7, 2005 for a painful five-month tumefaction of his right shoulder and left hand related to a trauma resulting from a fall. The clinical examination showed a 37.8 ° C febricule, an abscess on the left hand, a pain and tumefaction on the left shoulder the punction of which drained pus out. The bacteriological examination of these different samples did not isolate any germ. The standard radiography showed osteoarthritic lesions on the left shoulder and lesions on the third left metacarpal. Repeated arthrotomies, a fattening of the hand abscess and a non specific antibiotherapy did not improve the symptoms. Intradermal tuberculin test was highly positive. The biopsy of the hand and shoulder showed caseous necrosis and an epithelio-giganto- cellular follicle. The antituberculosis treatment which had been started six months after the first consultation did not cure him. He died of meningo-encephalitis. Conclusion: The diagnosis of shoulder tuberculosis among children was always late. One has to be able to identify it in front of a chronic suppuration of a shoulder which does not heal despite the non specific antibiotic treatment and vainly repeated arthrotomies. Introduction Tuberculosis is a contagious disease caused by a mycobacterium. Koch's bacillus is its main agent among human beings. The people who are most at risk are children, old people, immunodeficient individuals and people with a low socio-economic living conditions [1]. It prevails among men and affects 8 million people around the world [1]. The extrapulmonary forms are less common. Among these forms, the osteoarticular location is the rarest. It is evoked with clinical, radiological and laboratory signs. The definite diagnosis is based on the discovery of Koch's bacillus in the different samples or on the discovery, through histologic examination of an epithelo-giganto-cellular follicle associated or not with caseous necrosis. The cure is essentially medical and consists of a long term antituberculosis polychemotherapy. Surgery is specially reserved for functional after-effects. We are presenting two observations of osteoarticular tuberculosis, rare because of its location on a shoulder and because it affects children. Observation 1 EMD, a 14-year-old boy, with antecedents of an arm trauma that had occurred a year before, was examined on June 28, 2001 for a three-week fistular abscess. The clinical examination showed a weight of 31 kg, a temperature of 37.4° C, a suppurating fistular collection on the right shoulder. The radiography of the shoulder revealed lytic images of humeral head and the later of glenoid cavity.A diagnosis of an osteoarthritis of a right shoulder was made. A draining arthrotomy was carried out. The child was subjected to an oxacillin and gentamycin – based antibiotherapy and his shoulder was immobilised by a Mayo Clinic. The immediate effects were the outbreak of a 38.2° C fever, sweats, loss of weight and the persis