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• W2724293491 abstract "An 18-month-old boy was referred to our tertiary institution with a 2-month history of a left-sided intermittent painful limp. He had been living on Mayotte, an island located in the Indian Ocean, where he had been vaccinated with Bacillus Calmette-Guérin at birth. Physical examination showed no fever, mild tenderness and swelling of the left knee, slightly limited in range of motion. Routine laboratory tests were within normal ranges. Plain radiographs showed a lytic lesion in the epiphysis of the distal femur (Fig. 1a) with no chest abnormality. Magnetic resonance imaging confirmed a large empty signal area within the epiphyseal ossification centre with no transphyseal spread (Fig. 1b). Suspecting a primary subacute epiphyseal osteomyelitis,1 open surgical drainage and curettage of the osseous lesion were performed. Given the patient's age, bone specimens were inoculated in Bactec PED Plus (Becton Dickinson, Sparks, NV, USA) culture vials to search for Kingella kingae in addition to routine microbiological cultures.2 Broad-spectrum polymerase chain reaction (PCR) targeting the universal 16S rRNA gene and real-time PCR targeting the cpn60 gene of K. kingae were also performed from fresh bone materials. As Mayotte is an endemic tuberculosis area, the search for mycobacteria was done by streaking bone specimens onto specific medium and by using real-time PCR assays targeting Mycobacterium species.3 Of these testings, the real-time PCR assay targeting M. tuberculosis was positive. Histologically, lesion specimens showed a non-specific inflammatory granuloma. The tuberculin skin test and Interferon-gamma release assay were not contributive. Human immunodeficiency virus antibody testing was negative. A whole-body 18F-fluorodeoxy-d-glucose-hybrid positron emission tomography–computed tomography revealed a disseminated mycobacterial disease spread to the left popliteal, inguinal lymph nodes and right adrenal gland area (Fig. 1c). Subsequently, the patient progressively improved with rifampicin, isoniazid, pyrazinamide and ethambutol for 3 months, followed by rifampicin and isoniazid for 9 months. Three years later, complete healing of the tuberculous lesions with no growth disturbance was observed. Childhood tuberculosis is a growing public health issue worldwide.4 The current shifting in population migration led to the re-emergence of uncommon forms of tuberculosis that are poorly recognised in toddlers, especially in low tuberculosis burden areas where K. kingae is the leading cause of osteoarticular infections in children aged 6–36 months.2, 3 An increase of awareness of clinicians and the use of appropriate imaging and molecular tools are required to establish the diagnosis of tuberculosis at an early stage and avoid long-term complications. Informed consent was obtained from the child's parents who authorised us to report the case." @default.
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• W2724293491 date "2017-07-01" @default.
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• W2724293491 title "An uncommon form of a common disease" @default.
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• W2724293491 doi "https://doi.org/10.1111/jpc.13552" @default.
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