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 Table of Contents  
Year : 2021  |  Volume : 13  |  Issue : 1  |  Page : 71

Multifocal skeletal tuberculosis with atypical imaging feature

Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq

Date of Web Publication16-Jun-2021

Correspondence Address:
Prof. Mahmood Dhahir Al-Mendalawi
P. O. Box 55302, Baghdad Post Office, Baghdad
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jotr.jotr_29_18

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How to cite this article:
Al-Mendalawi MD. Multifocal skeletal tuberculosis with atypical imaging feature. J Orthop Traumatol Rehabil 2021;13:71

How to cite this URL:
Al-Mendalawi MD. Multifocal skeletal tuberculosis with atypical imaging feature. J Orthop Traumatol Rehabil [serial online] 2021 [cited 2021 Dec 9];13:71. Available from: https://www.jotr.in/text.asp?2021/13/1/71/318405


I read with an interest the case report by Abdulla on the multifocal skeletal tuberculosis (TB) with atypical imaging features in an Indian patient published in the latest issue of J Orthop Traumatol Rehabil.[1] The author obviously stated that “We describe an immunocompetent patient with multifocal skeletal TB involving multiple vertebrae, ribs, and pelvis with empyema.”[1] However, the author did not address the diagnostic workup employed to confirm the immunocompetent status of the studied patient. The author only mentioned that “hemoglobin was 13.5 g/dl, total leukocyte count was 10,000/ml with normal differential, platelet count was 430,000/μl, and erythrocyte sedimentation rate was 57 mm in 1 h. Blood chemistries were normal. The Mantoux test was reactive.”[1] Contrary to what the author claimed, I assume that immunocompromised status ought to be seriously considered in the studied patient. Among immunocompromised states, human immunodeficiency virus (HIV) infection has a great priority. My assumption is based on the following point. With the development of more potent anti-TB drugs and improvement in the socioeconomic states, there has been a decrease in TB in many parts of the world. However, in the era of HIV epidemic, atypical and extrapulmonary TB pictures have been found to form the major constituent of new TB cases.[2] In India, HIV infection is still a worrisome health hazard. Although no recent data are yet present on the HIV seroprevalence in India, the available data pointed out to HIV seroprevalence of 0.26% compared with a global average of 0.2%.[3] Moreover, the prevalence of HIV/TB coinfection among HIV Indian patients has been reported to be substantial (12.3%) and 56% of TB lesions in patients with HIV/TB coinfection were found to be extrapulmonary.[4] It has been recommended that all TB patients in India should be evaluated for HIV risk factors and tested for HIV reactivity, whereas all HIV-positive cases must be screened for TB.[4] In the light of rarity of multifocal bony TB and prevailing HIV infection in India, I presume that conducting the diagnostic set of CD4 lymphocyte count and viral overload estimations was solicited in the studied patient. If that set was to disclose underlying HIV infection, the case in question could be truly considered a novel case report. This is because HIV-associated multifocal skeletal TB has never been reported in the world literature to date.

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There are no conflicts of interest.

  References Top

Abdulla MC. Multifocal skeletal tuberculosis with atypical imaging features. J Orthop Traumatol Rehabil 2018;10:77-8.  Back to cited text no. 1
  [Full text]  
Saleeb PG, Buchwald UK. Update on the epidemiology, diagnosis and therapy of tuberculosis in HIV-infected patients. Pneumologie 2014;68:666-75.  Back to cited text no. 2
Paranjape RS, Challacombe SJ. HIV/AIDS in India: An overview of the Indian epidemic. Oral Dis 2016;22 Suppl 1:10-4.  Back to cited text no. 3
Manjareeka M, Nanda S. Prevalence of HIV infection among tuberculosis patients in Eastern India. J Infect Public Health 2013;6:358-62.  Back to cited text no. 4


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