Rare Pathologies

Dangerous Errors in the Diagnosis and Treatment of Bony Tuberculosis by Dr. med. Alexander Herzog in volume 36/20090

We wish to point out that in this case, no actual tuberculosis was present; rather, the patient had non-tuberculous mycobacteriosis (NTM), caused by Mycobacterium avium intracellulare. The infection was finally successfully treated over a period of 2 years with antibiotic combination therapy including clarithromycin (1, 2).

Such pathologies are rare and often affect immunocompromised persons, especially patients with HIV infection.

In the described case, PCR of the microscopically positive direct specimen would have been advantageous as this allows for rapid distinction between tuberculosis and NTM.

Nowadays, an Interferon-Gamma-Release Assay (IGRA) may also facilitate this distinction, in particular since the tuberculin skin test was of limited diagnostic value in the present patient, who had previously undergone BCG vaccination (3).
DOI: 10.3238/arztebl.2010.0147c

Dr. med. Barbara Hauer
Prof. Dr. med. Robert Loddenkemper
Deutsches Zentralkomitee zur Bekämpfung der
Tuberkulose
Stralauer Platz 34
10243 Berlin, Germany
[e-mail]

References

1. Griffith DE, Aksamit T, Brown-Elliot BA, Catanzaro A, Daley C, Gordin F, et al.: An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175: 367–416.

2. Abraham E: Erratum: ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175: 744–5.

3. Hauer B, Loddenkemper R, Diel R: Interferon-Gamma-Tests (IGRAs) – neue diagnostische Möglichkeiten in der Tuberkulosekontrolle. Epidemiologisches Bulletin (Robert Koch-Institut) 2009; 11: 98–101.

4. Herzog A: Case report: dangerous errors in the diagnosis and treatment of bony tuberculosis [Gefährliche Fehler in Diagnostik und Therapie einer Knochentuberkulose]. Dtsch Arztebl Int 2009; 106(36): 573–7.