A 39-year-old black woman was admitted to the 1st Chair and Clinic of Obstetrics and Gynecology of the Medical University of Warsaw (Head: Prof. Leszek Bablok) due to diffuse abdominal pain, cahexia and fever. Findings on admission included severe anemia (RBC 2.19x106/mul, HGB 4.9 g/dl, HCT 17.2%), leukocytosis of 12.6x103/mul, thrombocytosis 572x103/mul and a significantly raised level of C-reactive protein (107 mg/l). Gynecological examination and performed ultrasound did not reveal any pathologies of the reproductive organs. In February 2007, the patient underwent surgery in the same Clinic for an inflammatory tumor of the lesser pelvis and pyonephrosis. Presence of oviduct tissue was determined in histopathological examination of the removed tumor.
Fever of up to 39.6 C persisted in the course of hospitalization despite the application of broad-spectrum antibiotics (ciprofloxacin, metronidazole and ampicillin with clavulanic acid followed by vancomycin and gentamicin) and pain became more intense. Findings in computed tomography examination of the chest and abdomen indicated a systemic disease: hepatomegaly, small, calcified spleen and disseminated bone lesions (Figure 1). All examined bone structures exhibited features of heterogeneous sclerotic remodeling. Some vertebral bodies were deformed with concave medial borders of vertebral end plates. Left femoral head was notably flattened with accompanying osteoarthritis of the hip joint (Figure 2). There was a reduction in height of the intervertebral disc at the Th10/Th11 level and osteolytic lesions in the anterior region of Th11 vertebral body - picture consistent with spondylodiscitis. Furthermore, there were pathological fractures visible within Th10 and Th11 vertebral bodies with atypical, sagittal course of fracture fissures. There was a large fluid collection in the perivertebral space anteriorly to Th9-Th12 vertebral bodies (Figure 3). Within the thoracic cavity, findings included consolidation in the lower lobe of the right lung and encapsulated fluid collections in the right pleural cavity (Figure 4).
Blood tests toward HIV, HBV, HCV and syphilis (TPHA) were performed on suspicion of a systemic infectious disease but they excluded the possibility of those diseases. Taking patient's origin and radiological picture into consideration, we suspected sickle-cell disease complicated by tuberculosis. Further diagnostics at the Institute of Hematology confirmed the diagnosis of sickle-cell anemia. A tuberculin test was also performed. Its positive result as well as clinical and radiological picture allowed for stating a diagnosis of organ tuberculosis. The patient was transferred to the Institute for Infectious Diseases for further treatment.