Unusual presentations of osteoarticular tuberculosis in two paediatric patients

Abstract

Tuberculosis is a universal mimicker and thus could be a differential diagnosis of any osteolytic lesion. Bone biopsy is crucial in these cases for culture and histological proof of tuberculous infection. This is a case report of two paediatric patients with unusual presentations of tuberculosis. One patient presented with knee pain and had imaged findings of an osteolytic lesion at the epiphysis. Interval scan showed spread of the lesion through the physis to the metaphyseal region. The second patient presented with hip pain and an osteolytic lesion of the acetabulum. He was subsequently found to have involvement of the brain and spine as well. Both patients were diagnosed with tuberculosis by bone biopsy for culture and pathological examination. They were treated successfully with antituberculous medications without chronic sequelae. These two patients showed that early recognition and prompt treatment are critical for management of tuberculosis to avoid chronic sequelae.

Multifocal osteoarticular tuberculosis of the extremities in an immunocompetent young man without pulmonary disease: A case report

“…The consequences of considerable diagnostic delays in multifocal osteoarticular TB can prove critical for patients, since such delays may lead to the spread of the infection from the bone to the adjacent joints and surrounding soft tissue, causing significant functional disabilities (8,9). The present study describes the case report of a patient that presented with multifocal extremity pain and swellings and, following several TB modalities, was diagnosed with multifocal osteoarticular TB.…”

Osteoarticular tuberculosis: increasing incidence of a difficult clinical diagnosis

“…To further complicate the issue, radiological findings are often atypical 1,5 and serological markers of infection are often equivocal. In the case of this patient, his symptoms had been present for over a year, and yet there were no clear clinical or radiological signs of infection to help guide diagnosis.…”

“…colloquially as 'the great mimicker', 1 and as a result many cases of foot tuberculosis do not present in a classical manner. To further complicate the issue, radiological findings are often atypical 1,5 and serological markers of infection are often equivocal.…”

“…1 It makes up less than 3% of cases of extra-pulmonary tuberculosis. As such, it has remained a diagnostic enigma despite improvements in investigative technology.…”

“…As such, it has remained a diagnostic enigma despite improvements in investigative technology. [1][2][3][4] It is an aggressive disease. Any significant delay in diagnosis may lead to spread of the infection from bone into adjacent joints and surrounding soft tissue.…”