Osteoarticular tuberculosis: A series of six cases diagnosed on fine-needle aspiration cytology

Abstract

A few studies are dealing with the role of fine-needle aspiration cytology in diagnosing osteoarticular tuberculosis (TB). The present study was undertaken to study the cytomorphological features of six cases of osteoarticular TB throughout 1 year, diagnosed by fine-needle aspiration cytology. The Papanicolaou, Giemsa, Ziehl–Neelsen, and periodic acid–Schiff stains were used in each case. The sampled material was also cultured in Lowenstein– Jensen media for Mycobacterium species and polymerase chain reaction assay for Mycobacterium tuberculosis. Histopathological findings were correlated whenever available. There were four male and two female patients. The age of the patients ranged from 15 to 53 years, with a mean age of 37 years. Most cases involved small bones (4/6) and long bones of upper and lower limbs (2/6). Radiologically, the suspected lesions presented as osteolytic lesions, fractures, and joint destruction. The smears showed epithelioid cell granulomas in 5 out of 6 cases (83.3%), multinucleate and Langhans’ giant cells in 3 out of 6 cases (50%), and only necrosis in 1 case (16.7%). Inflammatory cells were seen in the background in 5 out of 6 cases (83.3%). AFB was positive in 3 cases (50%). Culture in Löwenstein–Jensen media, done in three cases, showed growth of M. tuberculosis. PCR showed positivity for M. tuberculosis in all six cases. Fine-needle aspiration cytology is an easy procedure that can be used for the diagnosis of osteoarticular tuberculosis. Cytomorphologically, smears show epithelioid cell granulomas, multinucleated and Langhan’s’ giant cells, and necrosis.

Tuberculosis of the Right Fifth Metatarsal and Fourth Web Space Without Pulmonary Involvement: A Rare Case

“…Tuberculosis is a substantial contributor to morbidity and mortality in underprivileged countries in Asia, Africa, and Europe [1,5]. Mainly, this affects the lungs, and extrapulmonary infections are reported due to hematogenous spread from the lungs [1,9]. Further, other modes of transmission include a direct extension from adjacent lesions, lymphatic, or either reactivation of dormant tuberculosis bacilli in extrapulmonary organs.…”

“…Tuberculosis of the metatarsals has a female predilection, and these patients are usually reported in their 20s or 30s [ 12 ]. A third of these cases have pulmonary manifestations, which makes it essential to exclude pulmonary involvement in cases with tuberculosis of the metatarsals [ 9 ].…”

“…Tuberculosis of the metatarsals presents with a confusing picture like an ache at the site of infliction, swelling, and irritation on walking, which often mimics other musculoskeletal disorders and is therefore not disease-specific [ 4 ]. Nevertheless, symptoms like a painful swelling affecting a joint or bone with an insidious onset, an unhealed ulcer, and a sinus linked with a discharge should make the treating physicians circumspect about this disease [ 9 ].…”

“…As seen in this case, the results of radiography techniques are usually vague [ 4 , 9 ]. Common features noted on a radiograph may vary from joint effusion, lytic lesions, and periarticular osteoporosis to bone marrow oedema, tenosynovitis, or soft-tissue collections [ 4 ].…”

Tuberculous Osteomyelitis of the Left Fifth Metatarsal and Phalanx Without Pulmonary Involvement: A First-of-Its-Type Report

“…With about 2.2-4.7% incidence of tuberculosis of bones and joints in developed countries, this type of tuberculosis contributes to about 10-15% of total extrapulmonary tuberculosis [3]. These numbers increase to 15-20% in high-burden countries [3]. Foot and ankle tuberculosis make up about ten percent of total osteoarticular tuberculosis [4].…”