Resumo

OLIVEIRA, João et al. Trocanterite tuberculosa. Rev. Port. Ortop. Traum. [online]. 2012, vol.20, n.4, pp.471-477. ISSN 1646-2122.

Trochanteritis tuberculosis manifests itself in an early stage by nonspecific clinical symptoms, and because of this there is the need to support the diagnosis, even in a late phase, in imagiological, microbiological and anatomopathological examination of the peri-articular caseum. The authors report a case of a patient with long term complaints of a painful tumoration located on the anterior surface of the proximal third of left hip, without traumatic history associated. The imagiologic study of the tumoration was inconclusive, showing an osteolytic lesion localized to the greater trochanter and several multi-loculated fluid collections on the thickness of the muscles, what make us suspect of a malignant tumor, according to the PET result. A CT-biopsy guided as been performed, revealing the presence of a nonspecific granulomatous chronic inflammatory process. It has been drain and debrided and a white caseous substance as been collected for pathological and bacteriological examination. The histologic study showed a chronic granulomatous inflammatory process with granulomas tuberculoid-type, and the research of the Mycobacterium tuberculosis complex was positive. It has been instituted a quadruple therapy with Isoniazia, Ethambutol, Pyrazinamide and Rifampicin and, although initially there was a reduction of the tumoration and inflammatory signs, after 2 months of medical therapy he re-starts the symptoms of pain and local edema of the left hip, what lead us to a second surgery (debridement, bursectomy and sequestrectomy), maintaining the treatment with tuberculostatic and bactericide for a further 4 months. With 2 years of follow-up, the patient remains clinically and radiologically asymptomatic. Although rare, we emphasize the importance of the inclusion of bone tuberculosis on the differential diagnosis of patients with a prolonged painful trochanteric syndrome resistant to conservative treatment.

Palavras-chave : Bone tuberculosis; greater Trochanter; trochanteritis.

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