Natural variation and differential diagnosis of skeletal changes in tuberculosis

Abstract

Twenty-six documented cases (17 blacks, 9 whites) of skeletal tuberculosis from the Hamann-Todd Osteological Collection, Cleveland Museum of Natural History, were analyzed for lesion variability and patterns of multiple site involvement. In addition, several documented cases of pathologic conditions (osteomyelitis, vertebral fractures, and malignant bone tumors) that resemble skeletal tuberculosis were photographed and described for use in differential diagnosis. The range of variation of tuberculous lesions was found to be considerable. Thirty-eight percent (10/26) of the cases display skeletal lesions in two or more regions concomitantly. The average number of vertebrae affected, as well as the incidence of multiple bone involvement, were found to be higher in blacks. Certain combinations of skeletal lesions (e.g., spine-rib, spine-rib-sternum, and spine-hip) may be useful in the diagnosis of tuberculosis in dry bone material.

A first prehistoric case of tuberculosis from Britain

“…Although bony regeneration at lytic lesions is negligible in the present case, there is sub-periosteal bone deposition on walls of adjacent centra. This pattern has been observed in documented examples of spinal tuberculosis (Kelley & El-Najjar, 1980), and presumably reflects local irritation of the periosteum. Bony ankylosis may occur in about 10% of cases of vertebral tuberculosis (Steinbock, 1976: 182).…”

“…The discussion which follows draws upon the palaeopathological diagnostic criteria of Steinbock (1976), Kelley & El Najjar (1980), Ortner & Putschar (1985), Aufderheide &Rodriguez-Martin (1998) andOrtner (1999).…”

A 6500-year-old Middle Neolithic child from Pollera Cave (Liguria, Italy) with probable multifocal osteoarticular tuberculosis

“…However, the vertebral column of PO21 also shows cervical and sacral spine involvement, which is not common Niwayama, 1995: 2463). Similarly, the involvement of the neural arches observed is rare, although there are reports both clinically and bioarchaeologically (Buikstra, 1976;Kelley and El-Najjar, 1980;Kumar, 1985).…”

Diagnosis of Mercurial Teeth in a Possible Case of Congenital Syphilis and Tuberculosis in a 19th Century Child Skeleton

“…In tuberculosis diagnostic elements include osteolytic lesions on the thoracic and lumbar vertebral bodies [10,13,17]. Rib involvement including new bone formation, particularly periosteal reactions on the visceral surface [18][19][20][21] is now considered in the diagnosis of tuberculosis [22].…”