MULTIPLE CYSTIC TUBERCULOSIS OF THE BONES

MULTIPLE cystic tuberculous cranial lesions are uncommon. Meng and Wu have reported 40 cases involving the skull, and Gibson has described 32 cases involving multiple lesions over the skeletal system. These two reports point out that in countries where tuberculosis is prevalent, multiple tuberculous lesions of other bones are common. Jungling called attention to multiple cystic lesions in the bones in nine cases and chose to refer to the condition as osteitis tuberculosa multiplex cystica. The lesions he described were in the small bones of the hands and feet almost entirely, and occurred in adults. A large majority of the cases mentioned were not confirmed by recovery of the tubercle bacillus from the lesions. In recent years Lyford, Hsieh, et al, Stalmann, Kelly and Sailer, Law and Perham, Martin, Fox, Frost, and Martin and Fogel, have all reported cases of multiple tuberculous bone lesions. Most of these cases have sufficient information to confirm the diagnosis. However, since proven cases of multiple cystic tuberculosis are uncommon in pediatric literature, this being the fourteenth case reported, it seem worth while to record it. History: No. 222,524, T.B.E., a 13 months old white male child, was admitted with a complaint of subcutaneous swellings and fever for eight months9 duration. Except for several episodes of diarrhea the child was well until he was five months of age. At that time it was noticed that he had swellings on both sides of the neck. During the eight months prior to admission swellings appeared in the axilla, in the groin, on the anterior surface of the right upper leg, on the fourth finger of the right hand, and on the right side of the head. Some of the swellings attained the size of 1.5 cm. They did not increase or decrease in size. They never suppurated nor drained. The swellings were quite tender. At times the nodes softened, only to harden again. After the eighth month of life the child neither gained nor lost weight though he ate fairly well. He ran an intermittent fever, and, for one month prior to admission here, he ran a daily fever as high as 38.8°C. The child had been treated elsewhere with penicillin and X-ray therapy. A biopsy specimen taken from a node on the right side of the neck was sent to this hospital, and was reported as tuberculous adenitis. Past history revealed no exposure to tuberculosis. The mother and father had had negative chest X-rays elsewhere. The child had always received raw cow9s milk.