Primary tuberculosis of the fibular diaphysis: A rare case report

Abstract

Highlights Tuberculosis of long bones diaphysis is rare. High index of suspicion is required in patients presenting with chronic inflammatory swelling over the leg. Radiographic findings should always be correlated with invasive investigations such as biopsy and culture to reach a conclusive diagnosis. Anti-tubercular drug regimen is mainstay of treatment.

Tuberculosis of the Femur With Intramedullary Abscesses and No Pulmonary Foci in an Immunocompetent Male: A Rare Case

“…Skeletal tuberculosis makes up 1-2% of total tuberculosis cases and 10% of extrapulmonary cases [ 4 ]. Long-bone skeletal tuberculosis is a prime example of a medical imitator [ 8 ]. The non-specific presentation of tuberculosis in long bones, with generalized pain and swelling and minimal symptoms of inflammation, makes it a persistent challenge even with advances in medicine [ 10 ].…”

“…The most frequent location of the primary lesion is the metaphysis, from which it may either progress to the adjacent joint in the epiphysis or remain harbored [ 11 ]. Diaphysis involvement is infrequent [ 8 ].…”

“…Due to similarities with more common differentials such as cystic bone lesions, bone tumors, Brodie's abscess, persistent pyogenic osteomyelitis, or fungal/bacterial granulomatous lesions, tuberculosis in long bones, which typically presents as a single lesion with no specific signs and symptoms, often goes unnoticed [ 8 ]. The average delay in diagnosing bone tuberculosis was reported to be 6.6 months in a study by Akgul et al [ 12 ].…”

“…The infrequency of tubular disease incidence in bones and the lack of a recognizable radiological marker further contribute to the neglect of a proper diagnosis [ 8 , 13 ]. To make a final diagnosis for such a condition, clinicians must combine their understanding of the potential differentials with radiological examinations, evaluate the findings, and combine that with histopathological and culture sensitivity data [ 10 ].…”

“…Tuberculosis of the bones constitutes 25% of all extrapulmonary tuberculosis and is usually present in the spinal column, hip joint, and greater trochanter of the femur [ 6 , 7 ]. The incidence of involvement of the diaphysis of long bones in skeletal tuberculosis is extremely low, ranging from 1% to 3% in both endemic and non-endemic countries [ 8 ]. A case of a 19-year-old male is presented here, who was diagnosed with tuberculosis of the femur after a detailed workup.…”