Mal de Pott y diagnóstico inmunológico de tuberculosis, a propósito de un caso pediátrico

Tuberculosis (TB) remains a major health problem in the world. The clinical forms of TB in children are variable, pulmonary involvement occurs in two thirds of cases. In the remaining third, clinical forms incluye node, meningeal and osteoarticular involvement. Case report: 7 year old boy with a history of an osteolytic lesion of the right ischial branch. Three months later he presented with spondylodiscitis at L2-L3, associated with a large abscess in the right iliac psoas muscle. Pott's disease was suspected, and tuberculin test and T-SPOT®.TB test were performed, with a positive result. Antimicrobial treatment was initiated with isoniazid, rifampicin, pyrazinamide and ethambutol. After 30 days, Mycobacterium tuberculosis was isolated from psoas abscess. We discuss methods of TB diagnosis, with special emphasis on immunological methods: tuberculin test and interferon-gamma release assays. Methods of immunological TB diagnosis are an important contribution to the diagnosis of this disease, allowing early initiation of treatment.(AU) La tuberculosis sigue siendo un importante problema en salud en el mundo. Las formas clinicas de TBC en los ninos son muy variadas, presentandose en dos tercios de los casos compromiso pulmonar. En el tercio restante destacan los compromisos ganglionar, meningeo y osteoarticular. Caso clinico: varon de 7 anos que presento una espondilodiscitis L2-L3, asociada a un absceso en musculo psoas-iliaco derecho. Por sospecha de mal de Pott se realizo PPD y T-SPOT®.TB que resultaron positivos. Se inicio tratamiento antimicrobiano asociado con isoniazida, rifampicina, pirazinamida y etambutol. Despues de 30 dias, se aislo Mycobacterium tuberculosis del absceso del psoas. Se discute los metodos de diagnostico de TBC en pediatria, con especial enfasis en los metodos inmunologicos: reaccion de tuberculina y test de liberacion de interferon-gamma, los que son una importante contribucion para el diagnostico de esta enfermedad, permitiendo el pronto inicio de su tratamiento.(AU)