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Gökhan Nergizoglu, Neval Duman, Şehsuvar Ertürk, Kenan Keven, Kenan Ateş, Harun Akar, Gülşah Bademci, Çaglar Berk, Selim Erekul, Bülent Erbay, Oktay Karatan, A. Ergün Ertug, Tuberculosis of the skull in a patient on maintenance haemodialysis, Nephrology Dialysis Transplantation, Volume 14, Issue 8, August 1999, Pages 2019–2021, https://doi.org/10.1093/ndt/14.8.2019
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Introduction
The incidence of tuberculosis (TB) is increased in chronic haemodialysis (HD) patients, especially in areas where the disease is endemic in the general population [1–3]. Impairment of cellular immune function in chronic renal failure may have a role in the pathogenesis. Extrapulmonary manifestations such as lymph nodes and skeletal involvement seem to be more frequent in HD patients [4,5]. Skeletal TB accounts for 1% of all tuberculosis infections. Primary TB of the skull is very rare [6,7].
Case
A 38-year-old man was admitted to the hospital because of progressive painless right frontal swelling. He had been diagnosed with end-stage renal disease of unknown aetiology, and had been on maintenance HD treatment for 2 years. The patient did not have a history of diabetes or alcohol consumption. There was no history of TB in either his past or his family.
On physical examination, the blood pressure was 110/70 mmHg, pulse was 78/min, and the body temperature was 36.7°C. On the right frontal region, there was a soft, painless swelling of 3×5 cm in diameter. No erythema or sinus was noticed on the lesion. Other systems were normal and no abnormal findings were found on neurological assessment. Laboratory tests revealed the following: white blood cell count 12 300/mm3, platelet count 278 000/mm3, haematocrit level 29%, erythrocyte sedimentation rate 126 mm/h. Chest X-ray, computerized tomography (CT), and abdominal ultrasonography were normal. Urine and sputum cultures were negative for Mycobacterium tuberculosis. A slight increase in α2-globulin was found on protein electrophoresis. The X-ray of the skull showed a well-circumscribed solitary osteolytic bone defect in the frontal bone (Figure 1). Cranial CT scan confirmed the bony defect and documented the presence of a sequestrum in the right frontal region (Figure 2). Fine-needle aspiration of the lesion yielded purulent material. Microbiological culture including for anaerobes and fungi, Gram staining, and acid-resistant bacilli screenings were all negative.
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