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Letters to the Editor

Indian Pediatrics 2005; 42:955

Isolated Gluteral Tuberculosis


Gluteal tuberculous abscess is a well documented presentation of a caries spine and other local bony foci of tuberculosis. A primary gluteal tuberculous abscess is rarer still and has been previously reported in literature in adults. We present a case of isolated gluteal tuberculous abscess in a child.

A 4-year-old female child presented with history of recurrent abscess in the left gluteal region. She gives history of having received an antibiotic injection in the left gluteal region six months back. She underwent incision and drainage of a left gluteal abscess along with antibiotic therapy at monthly intervals for 2 months prior to being seen by us. BCG vaccination was given in the neonatal period on the left deltoid region. There was no known contact with TB patients. The lungs, spine, pelvis and proximal femur were clinically and radiologically normal. There were no neurological deficits. The clinical presentation of the abscess cavity was not different from a pyogenic abscess except for its chronicity. The abscess was drained and the wall sent for histopathological examination. It revealed a chronic inflammatory lesion with granulation tissue and focal granuloma formation suggestive of tuberculosis and demonstration of acid fast tubercle bacilli on Ziehl Neelsen staining. The patient had a dramatic response to anti-tuberculous therapy and remains disease free at one year follow up.

Caries spine causing a gluteal abscess has been reported in adults and children(1). Adjacent bony lesions can also at times cause gluteal abscess(2). When BCG vaccination is given in the gluteal region, subcutaneous abscess is known to occur(3). Intramuscular injections can very rarely predispose the underlying Koch’s bacilli to get fixed at the site leading onto a subsequent abscess. The distinction between a tuberculous abscess and injection abscesses caused by Mycobacterium fortuitum and M.chelonei is by a therapeutic trial of ATT to which the latter do not respond(4). An isolated tuberculous abscess is a rare phenomenon reported previously only in adults(5).

V.S. Jones,
C. Phillip,

Department of Pediatric Surgery,
Matha Hospital,
Thellakom PO,
Kottayam, Kerala 686 016, India.
E-mail: [email protected]

References

1. Kumar R, Chandra A. Gluteal abscess: a manifestation of Pott’s spine. Neurol India 2003; 51: 87-88.

2. Kim NH, Lee HM, Yoo JD, Suh JS. Sacroiliac joint tuberculosis: Classification and treatment. Clin Orthop 1999; 358: 215-222.

3. Peltola H, Salmi I, Vahvanen V, Ahlqvist J. BCG vaccination as a cause of osteomyelitis and subcutaneous abscess. Arch Dis Child 1984; 59: 157-161.

4. von Lichtenbert F. Infectious disease. In: Cotran RS, Kumar V, Robbins SL, editors. Robbins Pathologic basis of Disease. 4th ed. Philadelphia: WB Saunders: 1989. p 380.

5. Abdelwahab IF, Kenan S, Hermann G, Klein MJ. Tuberculous gluteal abscess without bone involvement. Skeletal Radiol 1998; 27: 36-39.

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