Professor SHAO Jing-ming's clinical experience of fire needling for bone-joint tuberculosis, tuberculous cervical lymphadenitis, ganglion cyst and thyrophyma is summarized. Professor SHAO used fire needling to treat bone-joint tuberculosis. The acupoints included ashi points and nearby acupoints, particularly local opposite acupoints (Neixiyan [EX-LE 4] and Dubi [ST 35], Yinlingquan [SP 9] and Yanglingquan [GB 34], Xuehai [SP 10] and Liangqiu [ST 34]), and for the patients with severe yin-cold syndrome, Yanghe decoction was additionally used. For tuberculous cervical lymphadenitis, fire needling was used at different stages. In the early stage, the nucleus was punctured with fire needling; in the middle stage, the pustule was punctured with fire needling combined with cupping; in the late stage, the fire needling was inserted into the fistula or sinus tract, and the surrounding granulation tissue was treated with horizontal penetrating needling. For ganglion cyst, fire needling combined with centro-square needling was applied. For thyrophyma, the surrounding needling with filiform was used; for simple thyroid mass and thyroid nodule, the surrounding needling with fire needling was used.
Acupuncture Points ; Acupuncture Therapy ; Ganglion Cysts ; Humans ; Lymphadenitis ; Tuberculosis, Osteoarticular

Calcaneus ; diagnostic imaging ; Female ; Humans ; Radiography ; Tuberculosis, Osteoarticular ; diagnosis ; diagnostic imaging ; Young Adult

We presented three patients with trochanteric tuberculosis and described the clinical and imaging findings of the infection. Histology revealed a necrotizing granulomatous bursitis and microbiology confirmed tuberculosis. All cases were successfully treated with bursectomy and curettage of the trochanteric lesion and antituberculous chemotherapy including isoniazid, pyrazinamide, rifampicin, and ethambutol.
Aged, 80 and over ; Antitubercular Agents/*therapeutic use ; *Bursitis/diagnostic imaging/pathology/therapy ; *Curettage ; Female ; *Femur/diagnostic imaging/pathology/surgery ; Humans ; Middle Aged ; *Tuberculosis, Osteoarticular/diagnostic imaging/pathology/therapy

Skeletal tuberculosis developing after trauma is a rare occurrence.We report a rare case of posttraumatic tubercular osteomyelitis of mid-tarsal bone of the right foot. Patient was treated with regular dressing and anti-tubercular drugs. Posttraumatic skeletal tuberculosis should be considered in patient with non-healing ulcer.
Adolescent ; Foot Diseases ; etiology ; therapy ; Foot Injuries ; complications ; Humans ; Male ; Osteomyelitis ; etiology ; therapy ; Tuberculosis, Osteoarticular ; etiology ; therapy

Spondylolisthesis coexisting with tuberculosis is rarely reported. There is a controversy whether spondylolisthesis coexists or precedes tuberculosis. Few cases of pathological spondylolisthesis secondary to tuberculous spondylodiscitis have been reported in the lumbar and lumbosacral spine. All cases in the literature presented as anterolisthesis, except one which presented as posterolisthesis of lumbar spine. Spondylolisthesis in the cervical spine is mainly degenerative and traumatic. Spondylolisthesis due to tuberculosis is not reported in the lower cervical spine. The exact mechanism of such an occurrence of spondylolisthesis with tuberculosis is sparsely reported in the literature and inadequately understood. We report a rare case of high grade pathological posterolisthesis of the lower cervical spine due to tubercular spondylodiscitis in a 67-year-old woman managed surgically with a three-year follow-up period. This case highlights the varied and complex presentation of tuberculosis of the lower cervical spine and gives insight into its pathogenesis, diagnosis, and management.
Aged ; *Cervical Vertebrae/pathology/radiography ; Female ; Humans ; *Spondylolisthesis/etiology/radiography ; *Tuberculosis, Osteoarticular/complications/diagnosis/pathology

OBJECTIVETo analyze the clinical manifestation of interferon gamma receptor 1 deficiency (IFN-γR1 deficiency) and to improve the recognition of this disease in children, decrease diagnostic errors and missed diagnosis.

METHODThe information of one case with IFN-γR1 deficiency (past history of illness, clinical manifestation, laboratory examination and treatment) were analyzed.

RESULTThe patient was a 19-month-old girl with IFN-γR1 deficiency, 1-2 weeks after she was vaccinated with BCG at the age of 18 months, she manifested with lymph nodes at the same site as vaccination site, and repeated rash. Examination found a mass in the right armpit, the size was 3 cm × 3 cm, protruded on the skin, tenacious in nature, poorly mobile. B-mode ultrasound showed right armpit chest heterogeneous hypoechoic mass; abdominal B-mode ultrasound showed pancreatic lymph nodes around the abdominal aorta and mild swelling; chest X-ray showed right axillary lymph nodes, increased double markings. Initial diagnosis was (1) bronchitis, (2) BCG vaccination reaction, (3) Sepsis? . After admission, the patient was given rifampicin + isoniazid + latamoxef + amoxicillin and clavulanate potassium, and then changed to meropenem and Fusidic acid, but treatment showed no improvement. After adding the treatment with anti-inflammatory treatment, i.e., gamma globulin and methylprednisolone, the fever subsided. Conventional treatment with rifampicin + isoniazid 3 months after discharge from hospital were effective, and the axillary lymph nodes were not palpable. Six months after BCG vaccination bone tuberculosis occurred. CT of left hip and left knee showed bilateral hip joint effusion, left distal femur and left proximal tibia bone destruction. Gene detection showed the presence of homozygous IFNγ-R1 gene mutation of c.114_135del(p.E38fsX54). Her parents are consanguinity, both were carriers. In the literature, 99 cases with IFN-γR1 deficiency were reported, 95% of the cases had disseminated tuberculosis, and in 60 cases the dissemination occurred after BCG vaccination.

CONCLUSIONIFN-γR1 is an extremely rare disease in children. If disseminated tuberculosis infection occured, especially after BCG vaccination, or if there were focal/multifocal bone tuberculosis, immune function with conventional detection is considered normal, then IFN-γR1 deficiency should be considered, and early genetic testing for confirming the diagnosis and selecting the appropriate treatment are needed.

Antitubercular Agents ; therapeutic use ; BCG Vaccine ; adverse effects ; Female ; Humans ; Infant ; Lymph Nodes ; diagnostic imaging ; pathology ; Mutation ; genetics ; Mycobacterium Infections ; diagnosis ; drug therapy ; microbiology ; Receptors, Interferon ; deficiency ; genetics ; Tomography, X-Ray Computed ; Tuberculosis, Osteoarticular ; diagnosis ; drug therapy ; microbiology ; Vaccination ; adverse effects

Adult ; Diagnostic Errors ; Femur ; Humans ; Male ; Osteomyelitis ; diagnosis ; Suppuration ; Tuberculosis, Osteoarticular ; diagnosis

A 30 year-old female visited our out-patient clinic with painful joint swelling in both hands and feet. Because she had tested positive for rheumatoid factor, and her inflammatory markers were elevated, the case was initially classified as rheumatoid arthritis (RA), according to the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria. However, radiographic examinations, including simple radiography and MRI, revealed that her peripheral bone lesions were compatible with bone tuberculosis. The patient also exhibited pulmonary tuberculosis (TB) on chest X-ray and CT examinations. She was treated with isoniazid (INH), rifampicin (RFP), ethambutol (EMB), and pyrazinamide (PZA), and exhibited a good response to these medications. The patient was diagnosed as having bone TB, and her peripheral bone lesions were resolved using anti-TB treatment. This was an uncommon case of bone TB mimicking RA.
Arthritis, Rheumatoid* ; Classification ; Ethambutol ; Female ; Foot ; Hand ; Humans ; Isoniazid ; Joints ; Magnetic Resonance Imaging ; Outpatients ; Pyrazinamide ; Radiography ; Rheumatic Diseases ; Rheumatoid Factor ; Rheumatology ; Rifampin ; Thorax ; Tuberculosis ; Tuberculosis, Osteoarticular* ; Tuberculosis, Pulmonary

BACKGROUND: Non traumatic osteonecrosis also known as  avascular necrosis (AVN),and tuberculous arthritis (TB    arthritis)most commonly present as chronic monoarticular conditions. Corticosteroid intake is known to predispose individuals to the development of these two conditions.                      
In AVN, corticosteroid remains to be the most common cause that leads to a final  common pathway of disrupting    blood supply to segments of bone causing cell death. In TB arthritis, corticosteroid renders  a patient relatively immunocompromised predisposing to this extrapulmonary infection.                                                                                                                                                         
The incidence of tubercular osteonecrosis in a patient with systemic lupus erythematosus is rare. A review of literature only showed one case report of tubercular osteonecrosis diagnosed by aspiration cytology. Since tuberculosis (TB) is a destructive but curable disease, early diagnosis  and  treatment  are essential.
OBJECTIVE: To present a case of tubercular osteonecrosis in a patient with systemic lupus erythematosus treated with anti-Koch's regimen and iloprost infusion.
CASE: A 27-year old Filipino female who was diagnosed with lupus nephritis and underwent three days  methylprednisolone pulse therapy. Lupus nephritis improved  and  was clinically inactive for two years. She  developed insidious onset of intermittent pain on her left knee, associated with swelling for four months with  subsequent right hip pain of one week duration. MRI of the left knee showed osteonecrosis and arthritis. Radiograph of the right hip showed osteonecrosis. She underwent arthrocentesis of the left knee and the synovial  fluid tested positive for tuberculosis by PCR. We started the patient on quadruple anti-Koch's regimen together with iloprost infusion which afforded clinical improvement. 
CONCLUSION: To our knowledge, this is the first reported case of a lupus patient with concomitant polyarticular osteonecrosis complicated by monoarticular tuberculous arthritis. Medical treatment, while it may be complicated by adverse drug events, is effective in symptomatic treatment, but a multidisciplinary approach is suggested for optimal outcome.

Human ; Female ; Adult ; Adrenal Cortex Hormones ; Arthritis ; Arthrocentesis ; Cell Death ; Early Diagnosis ; Iloprost ; Incidence ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Methylprednisolone ; Osteonecrosis ; Pain ; Polymerase Chain Reaction ; Tuberculosis, Osteoarticular

Tuberculosis (TB) occurring after a closed bone fracture in the patient with no history of TB and no evidence of TB infection at the time of initial fracture is a rare entity. We report one such case of a 48-year-old female, who presented in the emergency department with an olecranon fracture which was open reduced and internally fixed with tension band wiring. Patient presented in the outpatient department with serosanguineous discharge at 3 weeks after surgery. The discharge was sent for culture and sensitivity tests, and the patient was managed by antibiotics and daily dressings. There was wound dehiscence and the underlying implant was exposed, which was removed at 12 weeks after surgery. Repeat debridements and dressings continued for 6 months, but the discharge from the wound site continued. X-rays of the elbow performed at 6 months raised the suspicion of TB, which was confirmed by Ziel-Neelsen staining and histopathological examination of the debrided tissue. Following the confirmation, patient was put on antitubercular drugs. The patient responded to antitubercular drug therapy (ATT), the purulent discharge from the wound ceased, and eventually the wound healed after 2 months of starting ATT.
Arthritis, Infectious ; etiology ; Elbow Joint ; Female ; Fracture Fixation, Internal ; Humans ; Middle Aged ; Olecranon Process ; injuries ; Postoperative Complications ; Transforming Growth Factor beta1 ; physiology ; Tuberculosis, Osteoarticular ; etiology