Primary iliac bone tuberculosis: A case report

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Abstract

Tuberculosis is an infectious disease caused by the Mycobacterium tuberculosis complex. It is a major public health problem, and one of the world's leading causes of morbidity and mortality. It occurs in both pulmonary and extra-pulmonary forms, the pulmonary form being the most common. Primary iliac bone tuberculosis remains a rare clinical entity, even in endemic areas. Its diagnosis can be challenging due to its similarity to other bone conditions. We report a rare case of primary iliac bone tuberculosis in a 63-year-old patient on peritoneal dialysis, with the following medical history: hypertension, type II diabetes complicated by diabetic retinopathy and diabetic kidney disease. Recent advances in molecular biology, in particular with the advent of the Genexpert®, have considerably improved patient management, providing microbiological evidence in less than two hours.

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  1. Reviewers have highlighted minor changes that will improve the clarity and importance of the reported findings. Please be sure to address all reviewer comments and make corresponding changes in the text. Additionally, please include any lessons learned and recommendations for potential future cases to the discussion. For example, would you recommend that physicians check for extrapulmonary Mtb infection in any immunocompromised patients with similar presentation? Would you have changed anything about your diagnostic process? This is a rare and interesting case, and your experience with it will be valuable to other healthcare professionals. I would also ask that you provide more clarity on the "anti-tuberculosis" treatment used to resolve the patient's infection, including the names and doses of any antibiotics used.

  2. Comments to Author

    Dahou et al report a rare case of extra-pulmonary tuberculosis located in the iliac bone by using radiographic and molecular diagnostic tools. This work highlights the complementary nature of these tools in diagnosing atypical tuberculosis. The paper is written and presented clearly, but I have a few minor corrections for clarity. 1) Italicize genus species names (Mycobacterium tuberculosis). 2) In lines 66-69 the authors should mention what method of "molecular biology" was performed. 3) When using acronyms (IE shortening tuberculosis to "tb" or Koch's bacillus to "BK") provide the acronym with the first use of the word and use the acronym for subsequent uses. 4) From lines 139-144 is this referring to the patient in the case study? 5) Lines 139-144 seem out of place within the current paragraph. I suggest moving them to the case presentation or earlier in the discussion.

    Please rate the quality of the presentation and structure of the manuscript

    Good

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  3. Comments to Author

    Please ONLY put comments for the Author(s) in here The manuscript by Dahou et al. presents a case study of a 63-year-old patient undergoing peritoneal dialysis with a medical history of hypertension, type II diabetes complicated by diabetic retinopathy, and diabetic kidney disease. However, the primary diagnosis is not mentioned in the Abstract. Additionally, the manuscript is very poorly written, with unclear and incoherent sentences. There are several redundancies. Substantial revisions are necessary for clarity and readability. Line 27- Abstracts describe GeneXpert and are further mentioned only in the discussion PCR and MRI are not mentioned in the abstract Redundancy of full sentences in abstract and in discussion: Line 26-28 Recent advances in molecular biology, in particular with the advent of the Genexpert®, have considerably improved patient management, providing microbiological evidence in less than two hours. Line 150-153 Recent advances in molecular biology, in particular with the advent of the Genexpert ®, have considerably improved patient management, providing microbiological evidence in less than two hours. Line 18- Italicized "Mycobacterium tuberculosis" Line 23-Its diagnosis- The diagnosis of the disease can be challenging Line-24- replace by "in a 63-year-old patient who was on peritoneal dialysis, and had a medical history of hypertension, and type II diabetes which was complicated by diabetic retinopathy and diabetic kidney disease. Line-19-23 (Abstract) and 33-36 (introduction) both are copying the same statement. Please modify the abstract and incorporate the estimate of mortality, morbidity, case fatality rate globally and in a place where the patient belongs, and how many cases have been reported recently to the place where the patient belongs Line-26-28: Recent advances in molecular biology, notably with the introduction of GeneXpert®, have significantly enhanced patient management by providing microbiological results in under two hours. Line 35-36-Reference Line 38- remove extremely Linbe 40-42- replace with "Accurately diagnosing this condition can be challenging, as its symptoms often resemble those of many other diseases. We present a rare case of primary iliac bone tuberculosis in a patient undergoing peritoneal dialysis. Line 44- The patient's belonging geographical region and travel history are missing Line 46- Please re-write the initiated on Peritoneal dialysis since 2021 by a peritoneal dialysis catheter" Line 49-Re-write "The patient reported weight loss of 10 kg for 1 month" Line-50- rewrite "hindering walking". Line-55- rewrite "Microbiologically, cytobacteriological examinations" Line-59- rewrite "three successive days, as well as molecular biology approaches" Line-61- remove : and write in sentences Line 66-italicized "Mycobacterium tuberculosis" Line 67- complex?? Line 69- returned positive, and should be turned positive Line 70- established should be replaced with confirmed by Line-72-sentence doesn't make sense, please rewrite "The patient was started on anti-tuberculosis treatment with dosages adjusted to his renal function" Legend writes are not aligned and justified properly Figure 1: The image description inside the figure is not visible. Please revise the with clear bar and discerptions or write detail parameters in the legend Figure 2: What does it signify? Figure 3: Rewrite "Ultrasound of soft tissues (gluteal muscles) showing a gluteal collection measuring 85 5.08 cm x 4.65 cm. Line-87 Which infection? Please re-write "Infections remain a major concern in terms of morbidity and mortality among dialysis patients. Line-92-96- should go in introduction Line 101- observed in our patient, replace with "in the present case study" Line-106- particularly in our context, please write as of patient or in this case study rather than our context Line-109 In our patient's case: see above Line 115- Bacillus- bacillus Line 115-remove special Line 149- Its diagnosis- please correct the sentence

    Please rate the quality of the presentation and structure of the manuscript

    Very poor

    To what extent are the conclusions supported by the data?

    Partially support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes