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Osseous Manifestation of Systemic Mastocytosis in a Paediatric Bone Scan: A Case Report

Volume 7 | Issue 3 | September-December 2021 | Page: 46-49 | Nurnadiah A Denil, Siti Zarina A Hassan DOI-10.13107/ijpo.2021.v07i03.124 Authors: Nurnadiah A Denil MMed Nucl. Med. [1], Siti Zarina A Hassan MMed Nucl. Med. [1] [1] Department of Nuclear Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia. Address of Correspondence Dr Nurnadiah A Denil Department of Nuclear Medicine, […]

Sternal Tuberculosis in an Infant: The Presenting Feature of Disseminated Disease

Volume 7 | Issue 3 | September-December 2021 | Page: 42-45 | Vikas R. Basa, Raghavendraswami Thete, Tanu Singhal DOI-10.13107/ijpo.2021.v07i03.123 Authors: Vikas R. Basa DNB Orth. [1], Raghavendraswami Thete DNB Orth. [1], Tanu Singhal MD Paediatrics, MSc Infectious Disease [1] [1] Department of Pediatric Orthopedics, Centre for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital & Medical Research Center, […]

Osseous Manifestation of Systemic Mastocytosis in a Paediatric Bone Scan: A Case Report

Sternal Tuberculosis in an Infant: The Presenting Feature of Disseminated Disease

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Osseous Manifestation of Systemic Mastocytosis in a Paediatric Bone Scan: A Case Report

Volume 7 | Issue 3 | September-December 2021 | Page: 46-49 | Nurnadiah A Denil, Siti Zarina A Hassan

DOI-10.13107/ijpo.2021.v07i03.124

Authors: Nurnadiah A Denil MMed Nucl. Med. [1], Siti Zarina A Hassan MMed Nucl. Med. [1]

[1] Department of Nuclear Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.

Address of Correspondence
Dr Nurnadiah A Denil
Department of Nuclear Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
E-mail: nadiahdenil@yahoo.com

Abstract

Systemic mastocytosis is a rare disorder of the mast cells with a wide spectrum of clinical manifestations depending on the organs involved.
We report a case illustrating the role of Tc-99m hydroxyl diphosphonate (HDP) to assist in diagnosing systemic mastocytosis in a 4-year-old girl who presented right thigh pain and intermittent fever. She initially presented with right thigh pain. The findings of the radiograph of the lower limbs were unremarkable. MRI of the right femur showed heterogenous intramedullary signal within the right femur, involving the diaphysis and metaphyseal region. Based on the radiographs and MRI changes, the differential diagnosis of disseminated acute osteomyelitis was made. Bone scan with Tc-99 hydroxy diphosphonate (HDP) performed showed diffuse skeletal uptake involving the appendicular and axial skeleton. Bone biopsy of the femur showed the presence of mast cell infiltration.
Diagnosing systemic mastocytosis remains challenging due to the contradictory results of available imaging modalities. When interpreting a focal or diffuse uptake on bone scintigraphy, systemic mastocytosis should be considered, particularly in the paediatric age group.
Keyword: Systemic mastocytosis, Tc-99m bone scintigraphy

References

1. Arrington ER, Eisenberg B, Harthshorne MF. Nuclear Medicine Imaging of Systemic Mastocytosis. J Nuclear Med (1989) 30: 2046-2048. (1989).
2. Fritz J, Fishman EK. Advanced imaging of skeletal manifestations of systemic mastocytosis. Skeletal Radiol (2012) 41; 887-897.
3. Frieri, M, Quershi, M. Pediatric Mastocytosis: A review of the literature. Pediatric allery, immunology and pulmonology (2013) Volume 26, number 4
4. Zettinig G, Becherer A, Szabo M, Uffmann M, Dudczak R, Valent P. FDG positron emission tomography in patients with systemic mastocytosis. AJR Am J Roentgenol. (2002);179:1235–7.
5. Pieri L, Bona Donna P, Elena C et.al, Clinical presentation and management practice of systemic mastocytosis. A survey of 460 Italian patients. Am J Hematol (2016) Apr 7.
6. Chen CC.; Andrich MP., Mican JM. A retrospective analysis of Bone Scan Abnormalities in Mastocytosis: Correlation with Disease Category and Prognosis. J Nucl Med (1994) 35; 1471-1475.
7. Lawrence JB, Friedman BS, Travis WD. Hematologic manifestations of systemic mast cell disease: a prospective study of laboratory and morphologic features and their relation to prognosis. Am J Med (1991) dec;91 (6): 612-24.

How to Cite this Article: Denil NA, Hassan SZA | Osseous Manifestation of Systemic Mastocytosis in a Paediatric Bone Scan: A Case Report | International Journal of Paediatric Orthopaedics | September- December 2021; 7(3): 46-49.

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Sternal Tuberculosis in an Infant: The Presenting Feature of Disseminated Disease

Volume 7 | Issue 3 | September-December 2021 | Page: 42-45 | Vikas R. Basa, Raghavendraswami Thete, Tanu Singhal

DOI-10.13107/ijpo.2021.v07i03.123

Authors: Vikas R. Basa DNB Orth. [1], Raghavendraswami Thete DNB Orth. [1], Tanu Singhal MD Paediatrics, MSc Infectious Disease [1]

[1] Department of Pediatric Orthopedics, Centre for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital & Medical Research Center, Mumbai, Maharashtra, India.
[2] Department of Paediatrics, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai, Maharashtra, India.

Address of Correspondence
Dr Vikas R Basa
Consultant Pediatric Orthopedics, Centre for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital & Medical Research Center, Mumbai, Maharashtra, India.
E-mail: basavikas@gmail.com

Abstract

We report here the case of a 9 month old previously healthy female infant who presented with a swelling over the anterior chest wall. Radiologic, histopathology and microbiologic tests confirmed it as a case of sternal tuberculosis. The sternal disease improved after starting anti-tubercular therapy but she then developed seizures due to a paradoxical reaction leading to unmasking of a brain tuberculoma. She is well after 1 year therapy. The case is presented in view of rarity of musculoskeletal tuberculosis in infants and even rarer phenomenon of sternal involvement.
Keywords: Infant, Sternal tuberculosis, Tuberculoma

References

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3. Behr MA, Edelstein PH, Ramakrishnan L. Revisiting the timetable of tuberculosis. BMJ. 2018 Aug 23;362:k2738.
4. Rodrigues LC, Diwan VK, Wheeler JG. Protective effect of BCG against tuberculous meningitis and miliary tuberculosis: a meta-analysis. Int J Epidemiol. 1993 Dec;22(6):1154-8. doi: 10.1093/ije/22.6.1154. PMID: 8144299.
5. Saifudheen K, Anoop TM, Mini PN, Ramachandran M, Jabbar PK, Jayaprakash R. Primary tubercular osteomyelitis of the sternum. Int J Infect Dis. 2010 Feb;14(2):e164-6.
6. Mushkin AIu, Maliarova EIu, Dzhankaeva OB, Kirillova ES, Il’ina NA. Tuberculosis of the sternum in children]. Vestn Khir Im I I Grek. 2010;169(2):52-6.
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9. Bohl JM, Janner D. Mycobacterium tuberculosis sternal osteomyelitis presenting as anterior chest wall mass. Pediatr Infect Dis J 1999; 18: 1028-9.
10. Kutty S, Bennett D, Devitt A, Dowling FE. Tuberculous osteomyelitis of the sternum in an infant: a case report and review of the literature. Pediatr Int. 2002 Apr;44(2):186-8.
11. Kato Y, Horikawa Y, Nishimura Y, Shimoda H, Shigeto E, Ueda K. Sternal tuberculosis in a 9-month-old infant after BCG vaccination. Acta Paediatr 2000;89:1495—7.
12. Carazo Gallego B, Moreno-Pérez D, Nuñez Cuadros E, Mesa Fernandez A, Martin Cantero M, Obando Pacheco P, Urda Cardona A. Paradoxical reaction in immunocompetent children with tuberculosis. Int J Infect Dis. 2016 Oct;51:15-18.
13. Bell LC, Breen R, Miller RF, Noursadeghi M, Lipman M. Paradoxical reactions and immune reconstitution inflammatory syndrome in tuberculosis. Int J Infect Dis. 2015 Mar;32:39-45.
14. Wen H, Li P, Ma H, Lv G. Diagnostic accuracy of Xpert MTB/RIF assay for musculoskeletal tuberculosis: a meta-analysis. Infect Drug Resist. 2017 Sep 28;10:299-305.
15. Kumar A, Gupta D, Nagaraja SB, Singh V, Sethi GR, Prasad J; Indian Academy of Pediatric. Updated national guidelines for pediatric tuberculosis in India, 2012. Indian Pediatr. 2013 Mar;50(3):301-6.
16. Bains L, Lal P, Chand T, Gautam KK, Beg MY, Kumar P. Isolated primary cold abscess of the sternum: a case report. J Med Case Rep. 2019 Aug 25;13(1):267.

How to Cite this Article: Basa VR, Thete R, Singhal T | Sternal Tuberculosis in an Infant: The Presenting Feature of Disseminated Disease | International Journal of Paediatric Orthopaedics | September- December 2021; 7(3): 42-45.

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Half Sized Blog Element (Multi Author Style)

Osseous Manifestation of Systemic Mastocytosis in a Paediatric Bone Scan: A Case Report

Sternal Tuberculosis in an Infant: The Presenting Feature of Disseminated Disease

Osseous Manifestation of Systemic Mastocytosis in a Paediatric Bone Scan: A Case Report

Sternal Tuberculosis in an Infant: The Presenting Feature of Disseminated Disease

Full Sized Blog Element (Big Preview Pic)

Osseous Manifestation of Systemic Mastocytosis in a Paediatric Bone Scan: A Case Report

Authors: Nurnadiah A Denil MMed Nucl. Med. [1], Siti Zarina A Hassan MMed Nucl. Med. [1]

Abstract

(Article Text HTML) (Full Text PDF)

Sternal Tuberculosis in an Infant: The Presenting Feature of Disseminated Disease

Authors: Vikas R. Basa DNB Orth. [1], Raghavendraswami Thete DNB Orth. [1], Tanu Singhal MD Paediatrics, MSc Infectious Disease [1]

Abstract

(Article Text HTML) (Full Text PDF)

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