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Technetium 99-m bone scan demonstrated increased uptake at the skull, both clavicles and both humeral heads.
Source publication
The incidence of bone tuberculosis is less than 5% of all tuberculosis cases. Furthermore, multifocal bone tuberculosis is uncommon, which rarely occurs without primary foci. It is difficult to diagnose, particularly if it is localized in both humeral heads. On the other hand, the isolated iliac bone tuberculosis is exceptional; it constitutes, als...
Context in source publication
Context 1
... mobility due to pain. The X-rays of both shoulders showed geodes and lytic lesions at both humeral heads (Fig. 1). The computed tomography scan was performed that suggested either multiple myeloma or diffuse bone tuberculosis (Fig. 2). The Technetium 99-m bone scan revealed increased uptake at the skull, both clavicles and both humeral heads (Fig. 3). Biologically: Mantoux test was positive, erythrocyte sedimentation was at 110 mm/h; C-reactive protein was at 15 mg/l; and white blood cell count, serum calcium, serum phosphorus, protein electrophoresis and QuantiF-ERON test were normal. A few days later, a biopsy of the left humeral head was performed. Two weeks later, the ...
Citations
... In extrapulmonary tuberculosis, the most common sites are the lymph nodes, followed by the skeletal system [1]. Of all the tuberculosis cases, the incidence of skeletal tuberculosis is less than 5% [5]. The present case is an extremely rare case of simultaneous involvement of the iliac bone and acetabulum with iliopsoas, obturator internus, and externus abscesses in a 15-year-old Indian female. ...
Skeletal tuberculosis is a rare form of extrapulmonary tuberculosis. Due to non-specific clinical features, these cases are often diagnosed very late, ultimately affecting treatment outcomes. The present case is a very rare case of tuberculosis of the iliac bone and acetabulum with iliopsoas, obturator internus, and obturator externus abscesses in an Indian female. She reported pain in her right hip and a limp. It was a difficult diagnosis, especially due to the rare involvement of bones and muscles in the absence of any lesions in the lungs. Nevertheless, the diagnosis was achieved by a detailed radiometric and laboratory workup. She was initiated on antituberculous treatment per her weight for 12 months.
... As discussed earlier, this could indicate either the absence of mycobacteria in the bone sample or a false-negative error caused by technical limitations. Real-time PCR is considered highly specific but shows only approximately 60% sensitivity under optimal conditions (Al-Zamel, 2009), and the formalin sample fixation method we used has been shown to further decrease sensitivity (Rish et al., 1996;Krebs et al., 2000;Bourlon et al., 2017;Vitošević et al., 2018;Elghoul et al., 2020). ...
Mycobacteriosis is an uncommon infection that has been sporadically described among wild, farmed and pet rabbits. To date, only one case of Mycobacterium genavense infection has been reported in a dwarf rabbit presenting with granulomatous pneumonia. This new case report describes granulomatous splenitis caused by M. genavensein a pet rabbit brought infor lameness caused by a femoral fracture. The initial blood test, X-ray, abdominal ultrasound, and bone marrow and spleen cytology results were consistent with a diagnosis of a metastatic giant-cell tumour. The rabbit underwent successful femoral osteosynthesis, and six months later, following the occurrence of a second spontaneous fracture and a worsening of overall health, the patient was euthanised. The postmortem histological examination showed severe granulomatous splenitis caused by acid-fast bacilli identified as M.genavensebyreal-time PCR analysis. The route of infection remains unknown, yet the lack of pulmonary involvement likely rules out airborne transmission. M. genavense infection, although rarely described in pet rabbits, appears to be an emerging pathogen and should be included among the differential diagnoses for pneumonia and splenomegaly. © 2023,Journal of the Hellenic Veterinary Medical Society. All Rights Reserved.
... Primary iliac bone TB is extremely rare and poses a diagnostic challenge [5]. The situation becomes even more challenging when the patients report late. ...
... Skeletal TB is the second most common site for extrapulmonary TB after the lymph nodes [7]. The incidence of skeletal TB is less than 5% of all TB cases [5]. Further, skeletal TB is commonly reported in the spine and long bones and the same in cancellous bones is less common [7]. ...
... Further, skeletal TB is commonly reported in the spine and long bones and the same in cancellous bones is less common [7]. Furthermore, isolated iliac bone TB is extremely rare, and it accounts for less than 1% of all skeletal TB cases [5,7]. Iliac bone TB is usually reported in conjunction with sacroiliac TB and very few reports of isolated iliac bone TB are available in the literature [7]. ...
Tuberculosis (TB) is a public health issue and is one of the main contributors to morbidity and mortality. The disease is very common in endemic areas. TB mainly occurs in the lungs; however, it can spread to other organs and the same is widely reported. Cancellous bone TB like that in the iliac bone is a rare finding even in endemic areas. The pandemic of coronavirus disease (COVID-19) has resulted in the delayed reporting of many cases. The present report is of a unique case of primary iliac bone TB in an Indian female who presented with painful swelling in her left thigh for three months. A detailed clinical work-up was done to establish the diagnosis. The delay was due to COVID-19 lockdowns and management was initiated after three months. This case highlights the importance of a high degree of suspicion to diagnose TB in rare extrapulmonary sites like the iliac bone.
Introduction
Despite tuberculosis being rampant in the Indian subcontinent, most cases of osteoarticular (OA) tuberculosis (TB) are missed until significant bony destruction has occurred. Initial presentation of extra-pulmonary TB mimics many other disease entities while many diseases mimic TB. This may lead to an incorrect diagnosis and sometimes creates a dilemma in reaching the correct diagnosis. The aim of this study was to evaluate a series of pediatric cases of osteoarticular TB, which posed a diagnostic challenge to us.
Material and methods
Retrospective analysis of case records of pediatric OA-TB patients who had presented to two tertiary level centers of urban India between February 2016 and December 2020 was done. There were a total of 69 patients.
Observations
There were 37 males and 32 females. The age range was from two to 17 years. Forty-four patients showed evidence of disease within the spine (dorsal region followed by lumbar, followed by the cervical spine), 16 showed disease of the extremities, six had disease of the girdle bones, and three showed disease of the short bones of hands or foot. In our series, patients presented to us between 15 days to six months from the onset of symptoms. From our series, six cases with atypical clinical pictures have been selected for presentation purposes. In all six cases, the initial presentation was not that of OA-TB. However, with a high degree of suspicion, differential diagnosis of TB was kept in mind, and the diagnosis was confirmed microbiologically.
Conclusion
A high degree of suspicion is required to avoid missing the diagnosis of osteoarticular TB. Non-invasive advanced radiological investigations such as MRI and microbiological analysis of biopsy specimens aid in arriving at the correct diagnosis.
