The authors report the treatment of a hemodialysis patient who developed a rare case of carpal bone tuberculosis. A 63-year-old woman on hemodialysis for 3 months, beginning in January 2000, complained of swelling and pain in her right hand and a fever of unknown origin. A prolonged unexplained fever that lasted for 2 weeks had occurred before the beginning of right hand pain. Radiographs showed an extensive cystic lesion of carpal bone thought to be due to osteomyelitis. The lesion was incised and evacuated. The aspirated fluid proved sterile on culture. For 2 weeks cefazolin sodium antibiotic substance was given, but the local symptoms did not improve. Curettage and drainage were performed. Histological examination revealed granulomas with central necrosis, epithelioid cells and multinucleated giant cells of Langhans type. Cultures revealed Mycobacterium tuberculosis. Antitubercular drugs were given postoperatively.
The hemodialysis patients have low cellular immunity, and are likely to suffer from tuberculosis more often than healthy persons. Tuberculosis should be considered, when a hemodialysis patient has osteolysis and fever of unknown origin.
