Case 3 is a female of 3 years and 7 months old. She was admitted in the hospital for presenting intense pain and walking limitation of approximately 5 months of evolution. Analysis of her referral studies consisting on tomographic evidence depicted a lytic lesion on the acetabulum in the iliopubic eminence and anterior-inferior iliac spine with thinning and rapture of the cortical bone. Moreover, a referral biopsy performed in February, 2016, showed hemorrhagic material with few groups of histiocytes and giant multinucleated Langerhans cells and chronic granulomatous inflammation compatible with Tuberculosis. In view of the above, she was referred to NIP by the National Institute of Rehabilitation for comprehensive evaluation. The BCG immunization record depicted the application of the vaccine at birth in July, 2015.
On being referred to the institute for presenting intense pain with walking limitation, she was attended in the outpatient service of the Orthopedic Department. Extension studies performed before her admission in the institute consisted of bone gammagraphy done on 19th January, 2016, with report of normal metabolic activity; and bone biopsy, performed on 18 February, 2016, where chronic granulomatous inflammation was appreciated. Upon admission, the approach was complemented with pelvic radiography, performed on 23rd March, 2016, which showed the presence of lytic lesion on the right acetabulum. Based on the biopsy report, the Infectious Disease Service decided to start treatment based on isoniazid, 10 mg/kg/day; rifampicin, 15 mg/kg/day; pyrazinamide, 20 mg/kg/day; and ethambutol, 25 mg/kg/day. She was also assessed by the Immunology Service with report of good clinical evolution. The laboratory exams of 6th April, 2016, of the patient reported hemoglobin of 13.3(g/dL), hematocrit of 39.9 (%), Leucocytes of 10.4 (103/mm3), neutrophils of 5.7 (103/mm3), lymphocytes of 3.4 (103/mm3), platelets of 404 (103/mm3), and normal nitroblue tetrazolum test, without significant hereditary family history or other infectious events suggestive of inflammatory demyelinating polyneuropathy (IDP).