Objective

This case-study provides a summary of skeletal lesions seen in a case of diagnosed juvenile pulmonary tuberculosis with extensive multifocal bony lesions.

Materials

Skeleton of a 9-year-old girl who died in the 1940s in Lisbon, Portugal. The remains of this individual are part of the Lisbon skeletal reference collection curated at the National Museum of Natural History and Science.

Methods

Lesions and paleopathological conditions were identified and documented through macroscopic, radiographic, computed tomographic, and mammographic analysis.

Results

The skeleton shows a variety of lytic lesions on the ribs and thoracic vertebrae including complete destruction of the bodies and fusion of the vertebral arches of four vertebrae, kyphosis, and scoliosis. Further pathological conditions were identified, including bone erosion, premature fusion of the left femoral head and greater trochanter, and abnormal size and shape changes to the lower limbs including loss of bone mass and stunting of the long bones.

Conclusions

Skeletal lesions are indicative of spondylitis, Pott’s disease, and prolonged bedrest.

Significance

This case is one of the few examples of confirmed juvenile pulmonary tuberculosis with skeletal lesions prior to the antibiotic era. As such, it provides a reference for the skeletal abnormalities which may be observed in archaeological tuberculosis cases.

Limitations

Pulmonary tuberculosis was recorded as cause of death, however there is no documentation to know the length of illness period or the existence of any comorbidities.

Suggestions for further research

Consideration of multi-focal lesions is recommended when analyzing individuals with suspected tuberculosis.

中文翻译：

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患有肺结核的儿童的严重骨骼病变、骨质减少和生长缺陷（20 世纪中叶，葡萄牙）。

客观的

本案例研究总结了一例诊断为具有广泛多灶性骨病变的青少年肺结核病例中所见的骨骼病变。

材料

1940 年代在葡萄牙里斯本去世的一名 9 岁女孩的骨骼。这个人的遗骸是里斯本骨骼参考收藏的一部分，收藏在国家自然历史和科学博物馆。

方法

通过肉眼观察、放射照相、计算机断层扫描和乳房 X 线照相分析，确定并记录了病变和古病理状况。

结果

骨骼显示肋骨和胸椎有多种溶解性病变，包括身体的完全破坏和四节椎骨的椎弓融合、后凸畸形和脊柱侧凸。进一步的病理状况被确定，包括骨侵蚀、左股骨头和大转子过早融合，以及下肢的异常大小和形状变化，包括骨量减少和长骨发育迟缓。

结论

骨骼病变表明脊椎炎、Pott 病和长期卧床。

意义

该病例是在抗生素时代之前确诊的具有骨骼病变的青少年肺结核的少数例子之一。因此，它为考古结核病病例中可能观察到的骨骼异常提供了参考。

限制

肺结核被记录为死因，但没有文件知道病期的长短或是否存在任何合并症。

进一步研究的建议

在分析疑似结核病患者时，建议考虑多灶性病变。