UNUSUAL CASES OF CHILDREN SKELETAL TUBERCULOSIS IN
SIBLINGS
*Heda Melinda D. Nataprawira,
*Oma Rosmayudi, *Paulina R., **Soehartinah K. Antono, **Atta Kuntara
*Department of Child Health, **Department of Radiology, Medical School
Padjadjaran University-Hasan Sadikin Hospital, Bandung, Indonesia
Skeletal tuberculosis
may involved any bone or joint but mainly affects the vertebrae and
weight-bearing bone and joints. However, tuberculous lesion are less
frequent in the bones of the shoulder, arm,and hands than in leg and foot.
Moreover, it occasionally occurs in children but very rarely found in
siblings. Two male siblings aged 13 1/2 and 12 years from low
socio-economic family with poorly treated known adult TB contact were
reported. They had been diagnosed as having pulmonary tuberculosis (PTB)
and extra-pulmonary TB (ETB) for the last two years, but inadequately
treated. On admisson for the third time, abdominal, skeletal and cutaneous
tuberculosis as well as PTB were found in the old sibling. He was severely
malnourished and had been poorly taking five antituberculosis drugs which
showed poor response. His long bone radiograph showed osteoporotic,
osteosclerotic, and destruction of lumbosacral vertebrae. Acid fast bacilli
(AFB) and polymerase chain reaction (PCR) test for TB from knee synovial
fluid were positive while it yielded negative from ascitic fluid. By active
contact tracing on the other siblings, we found tuberculous dactylitis or
spina ventosa in the short tubular bone of the hand, caries sicca on the
shoulder as well as pleural TB on the second sibling, radiographically. He
had also PTB and took medicine inadequately with poor response. The other
three siblings were then diagnosed as having PTB. It seems that similar
genetic predisposition exists in the family and the possibilities of having
the same presentations should be considered to occur in the other siblings
in the future.