Tuberculous Osteomyelitis in Young Children

Abstract

Twenty-three cases of tuberculous osteomyelitis in children were reviewed. Age at diagnosis ranged from 10 months to 11 years; 17 patients were younger than 3 years. At clinical presentation, patients were generally afebrile with local swelling and painful limb disability. Delay in diagnosis was common, with an average of 4.3 months. Laboratory data showed mild increase in white cell counts and erythrocyte sedimentation rates. However, C-reactive protein levels were all within normal limits except one. Roentgenograms demonstrated osteolytic lesions over metaphyseal areas with surrounding soft-tissue swelling. All patients had received BCG vaccinations at infancy. None of the patients had pulmonary tuberculosis. No familial or environmental history could be attributed to these victims, nor was any immunodeficient disease noted. Bacille Calmette-Guérin (BCG) vaccination was suspected to be the cause of tuberculosis in these young children. All patients received surgical debridement and oral antituberculosis chemotherapy for 1 year. After an average follow-up period of 71.4 months, all children had complete bony healing and excellent clinical results.

Concomitant cutaneous metastatic tuberculous abscesses and multifocal skeletal tuberculosis

“…Recently, the proportion of bone or joint tuberculosis has progressively increased to 27% 19. Although they are highly specific in the presented case, the clinical findings may not be specific, and in many cases, the radiographic appearance is similar to pyogenic osteomyelitis; therefore, the disease is frequently neglected or misdiagnosed.…”

“…The symptoms are those usually seen in musculoskeletal disorders; pain, stiffness, and swelling. The tuberculin test is positive in up to 90% of cases 27121520…”

Hand Infections

“…The pathophysiology is different in children, with metaphyseal osteomyelitis the initial pathology, which then crosses the growth plate into the joint [ 85 ], whereas in adults seeding of the synovium usually occurs fi rst [ 76 ]. Clinical presentation is as mono-or polyarthritis of the metacarpal or interphalageal joints, or arthritis of the wrist.…”

Spectrum of Tuberculosis in Human Body – A Radiologic Review

“…The differential diagnosis includes neoplasm, Brodie's abscess, chronic osteomyelitis, and other granulomatous lesions, biopsy is required to establish the diagnosis. [37] Arthritis :…”