Bone and Joint Disease

Bone and joint infection complicating tuberculosis is

most likely
to involve the vertebrae. The classic manifestation
of tuberculous spondylitis is progression to Pott
disease, in which destruction of the vertebral bodies
leads to gibbus deformity and kyphosis
Skeletal tuberculosis is a late complication of
tuberculosis and has become a rare entity since the
availability of antituberculosis therapy but is more
likely to occur in children
than in adults. Tuberculous bone lesions can
resemble pyogenic
and fungal infections or bone tumors. Multifocal
bone involvement can occur. A bone biopsy is
 Abdominal and Gastrointestinal Disease

1- Oral cavity or pharynx Tuberculosis is quite

unusual. The most common lesion is a painless
ulcer on the mucosa, palate, or tonsil with
enlargement of the regional lymph nodes.
2-parotid gland Tuberculosis of the has been
reported rarely in endemic countries.
3-Esophagus is rare in children but may be
associated with a tracheoesophageal fistula in
infants.

These forms of tuberculosis are usually associated

with extensive pulmonary disease and swallowing
of infectious respiratory secretions. However, they
can occur in the absence of pulmonary disease, by
spread from mediastinal or peritoneal lymph nodes.
 Abdominal and Gastrointestinal Disease

Tuberculous peritonitis occurs most often in

young men and
is uncommon in adolescents and rare in children.
Generalized
peritonitis can arise from subclinical or miliary
hematogenous
dissemination. Localized peritonitis is caused by
direct extension
from an abdominal lymph node, intestinal focus, or
genitourinary tuberculosis.
Rarely, the lymph nodes, omentum, and peritoneum
become matted and can be palpated as a doughy
irregular non-tender mass. Abdominal pain or
 Abdominal and Gastrointestinal Disease

Tuberculous enteritis is caused by hematogenous

dissemination or by swallowing tubercle bacilli
discharged from the
patient s own lungs. The jejunum and ileum near
Peyer patches
and the appendix are the most common sites of
involvement. The typical findings are shallow ulcers
that cause pain, diarrhea or constipation, weight
loss, and low-grade fever. Mesenteric adenitis
usually complicates the infection. The enlarged
nodes can cause intestinal obstruction or erode
through the omentum to cause generalized
peritonitisThe clinical presentation of tuber-culous
enteritis is nonspecific, mimicking other infections