A rare case of caries sicca right shoulder

Abstract

Caries sicca is the classic dry form of tuberculosis of proximal humerus. Caries sicca is a fairly rare extrapulmonary presentation of bone tuberculosis. It accounts for 0.9 to 1.7 percent of all extrapulmonary tuberculosis cases. A 23-year-old female presented to the orthopaedics outpatient department with complaint of pain and restriction of shoulder movements for 6 months. The patient has no history of tuberculosis previously, but has a history of a family member suffering from pulmonary Koch. On clinical examination there was tenderness over the Greater tuberosity with restricted external rotation, abduction up to 30 degrees with further passive abduction being painful. There was marked wasting of deltoid and other muscles. Patient´s biopsy was taken for histopathology which showed normal morphology of bony trabeculae, fibromuscular and fatty tissue infiltration of chronic inflammatory cells and at places epithelioid granuloma with langhans giant cells and caseous necrosis which favor the diagnosis of tuberculosis. The patient was started on chemotherapy antitubercular drugs with intensive phase of 2 months and continuation phase of 7 months. During the treatment period the patients were followed up clinic radiologically and the satisfactory shoulder movements abduction up to 90 degrees achieved after 9 months and erythrocyte sedimentation rate (ESR) was considered as a prognostic factor for treatment.