TO THE EDITOR:
We read "Tuberculous Abscess of the Brachialis and Biceps Brachii Muscles without Osseous Involvement. A Case Report" (80-A: 1521—1524, Oct. 1998), by Abdelwahab and Kenan, with interest.
There has been a recent resurgence of tuberculosis. McCulloch and Malone2 reported that sixteen (76 percent) of twenty-one patients with tuberculoisis had abnormal findings on radiographs of the chest. A ten-year review of all new cases of extrapulmonary tuberculosis at a major urban medical center revealed skeletal involvement in twenty (15 percent) of 136 patients1. Tuberculosis of the musculoskeletal system is generally the result of hematogenous dissemination. Occasionally, direct extension will occur from a visceral focus, such as the lungs, the kidneys, or the mesenteric lymph nodes.
Abdelwahab and Kenan stated that they were unable to find any other reports in which the tuberculous process affected only the muscles. One of us (S. S.) and colleagues reported a giant tuberculous abscess without osseous or visceral involvement3. We would like to know if their patient had a history of antibiotic therapy because the administration of nonspecific antibiotics may cause a tuberculous abscess of the soft tissue without osseous involvement.
Sinan Seber, M.D.; Nusret Köse, M.D.: Department of Orthopaedics and Traumatology, Osmangazi University Medical Faculty, Meselik, Eskisehir 26480, Turkey
Dr. Abdelwahab and Dr. Kenan reply:
We thank Dr. Seber and Dr. Köse for bringing this case report3 to our attention. We read the paper carefully and found it very interesting. Indeed, the authors pointed out the same finding that a tuberculous abscess in muscle without a primary focus in the lungs or vertebrae is extremely rare. Our patient was otherwise healthy and had no history of any infectious condition or antibiotic treatment. The tuberculous abscess was confined to the brachialis muscle without involvement of bones or joints, and the radiograph and computerized tomography scan of the chest revealed negative findings.
Although we performed what we thought was a thorough search of the literature, we clearly missed the article by Seber et al.3. We apologize for the oversight.
Ibrahim Fikry Abdelwahab, M.D.: Department of Radiology, Mount Sinai Medical Center, One Gustave Levy Place, Box 1234, New York, N.Y. 10029
Samuel Kenan, M.D.: Department of Orthopaedic Surgery, Hospital for Joint Diseases Orthopaedic Institute, 301 East 17th Street, New York, N.Y. 10003