Tuberculous osteomyelitis of tibial diaphysis following saphenous vein graft harvest for coronary artery bypass: a case
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CASE REPORT
Tuberculous osteomyelitis of tibial diaphysis following saphenous vein graft harvest for coronary artery bypass: a case report Sumit Arora 1
&
Jatin Talwar 2 & Vikramadittya Singh 3 & Vikas Gupta 2
Received: 12 June 2020 / Revised: 27 June 2020 / Accepted: 2 July 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract Tuberculosis in the tibial diaphysis following saphenous vein graft harvest for coronary artery bypass grafting has not been reported, to the best of authors’ knowledge. We report the first such clinical case in view of its clinical rarity and as a complication of the simple procedure like saphenous vein graft harvest. Keywords Tuberculosis . Coronary artery bypass grafting . Saphenous vein graft harvesting . Tibia osteomyelitis . Diaphysis
Introduction Tuberculous infection occurring after a surgical procedure, especially in the setting of no past history or current evidence of this infection, is a rare entity. It has been proposed that Mycobacterium may involve an implant site possibly by hematogenous spread from activation of a latent distant focus or local reactivation of dormant bacteria in a previously exposed individual [1]. Such tuberculous infection, often referred to as implantation tuberculosis, is an atypical presentation. This entity is reported in the literature mostly following fracture fixation [1–4]. Sternal tuberculosis following coronary artery bypass grafting (CABG) has also been reported sparsely [5]. Implantation tuberculosis in the tibial diaphysis following saphenous vein graft harvest (SVGH) for CABG has not been reported, to the best of the authors’ knowledge as a PubMed search with MeSH Major Topics of “tuberculosis,” “tibia diaphysis,” “cardiac * Sumit Arora [email protected] 1
Department of Orthopaedic Surgery, Maulana Azad Medical College & associated Lok Nayak Hospital, New Delhi-110002, c/o Mr Raj Kumar Arora, B-253, second floor, Derawal Nagar, Delhi 110009, India
2
Central Institute of Orthopaedics, Vardhman Mahavir Medical College & associated Safdarjung Hospital, New Delhi 1100029, India
3
Division of Orthopaedics, Bone & Joint Centre, Nawanshahr, Punjab 144514, India
surgery,” and “saphenous vein graft harvest” did not reveal similar publications. We report the first such clinical case in a 60year-old gentleman, who underwent CABG at another center for coronary artery disease (CAD). The case is presented in view of its clinical rarity and as a complication of the simple procedure like SVGH. We also discuss the pathogenesis of the condition, and possible measures to avoid this complication. The patient was informed that data concerning the case would be submitted for publication, and written informed consent authorizing the radiologic examination and photographic documentation was obtained.
Case report A 60-year-old gentleman presented to orthopedic outpatient department with a painful swelling and pus discharge from the middle-third of his left leg for the past 21 months. The swelling was insidious on onset that start
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