Troublesome Tuberculosis: A Case Report on Multi-focal Tuberculous Osteomyelitis in An Immunocompetent Patient

Abstract

Bone and joint tuberculosis is a chronic debilitating condition that leads to progressive damage and even deformity of joints. It may affect one or multiple sites. It could present in a myriad of ways which may result in an incorrect diagnosis being made. Common misdiagnoses include seronegative inflammatory arthritis, septic arthritis, malignancy, osteoporotic fractures and mechanical type back pain. It was initially only diagnosed in patients with previous active tuberculosis or latent tuberculosis. However, in recent years, it has also been reported in patients without a history of previous tuberculosis infection. Making a diagnosis of bone and joint tuberculosis is challenging. As the symptoms are not always typical, a delay in initiating anti-tuberculosis treatment is not uncommon in clinical practice. Systemic features are not always present in multi-drug resistant tuberculosis of joints which makes the diagnosis even more challenging. Multi-drug resistant tuberculosis is an increasingly common problem. It is not only limited to immunocompromised patients, but also found in immunocompetent patients. Multifocal tuberculous osteomyelitis is an uncommon condition and may involve any bone such as the skull, ribs, long bones, spine and phalanx. Tuberculous pyomyositis and tuberculous tenosynovitis may also be the presenting features of multifocal tuberculosis. Identification of mycobacterium tuberculosis in synovial fluid and biopsy, tissue culture, tissue fluid cytology and tissue polymerase chain reaction are crucial investigations in these cases. As the presentation of extra pulmonary tuberculosis can be very variable, it is important to maintain a high index of suspicion. The diagnosis and therefore treatment may be expedited using a clinically directed multidisciplinary approach.KeywordsBone and joint tuberculosis; Multi focal tuberculous osteomyelitis; Extra-pulmonary tuberculosis; Multi-drug resistant tuberculosis; Latent tuberculosis

Isolated Tuberculosis of the Ribs in an Immunocompetent Adult

“…Lynn et al have described multifocal skeletal TB (including rib lesions) in an immunocompetent patient. 8 Co-existent pulmonary disease is invariably absent in patients with rib TB, as it was in our patient. 9 Nakiyingi et al have reported on a young man with rib TB involving two ribs, constitutional symptoms, no lung involvement and excellent response to medical therapy similar to our patient.…”

Brain Tuberculomas: A Case Report

“…In 2008, 334 patients died from tuberculosis which is 0.6 per 100000 population. These data are significantly better, compared those of1955 in which 3900 patients died from tuberculosis with mortality rate of 8.8 per 100000 population ( 5 ). In 2012 report of a case presented with prolonged nonspecific symptoms and multiple brain tuberculomas demonstrated that diagnosis of such peculiar presentations is very important ( 6 ).…”

Chronic multifocal tubercular osteomyelitis in a young Nepalese boy: A rare case presentation

“…Multifocal tuberculous osteomyelitis is an uncommon condition and may involve any bone such as the skull, ribs, long bones, spine, and phalanx [8] . The presentation of extrapulmonary forms of TB can be very variable so a diagnosis should be in consideration in high-risk individuals and the endemic areas of the world.…”