Cystic Transphyseal Tubercular Osteomyelitis

Abstract

Tubercular osteomyelitis of shaft without the joint involvement is very rare. The most commonly associated symptoms are pain and swelling in the affected bone. Diagnosis is often delayed as radiologically it mimics Brodie's abscess, chronic pyogenic osteomyelitis, cystic lesions, tumours and other granulomatous conditions, either fungal or bacterial. Tuberculosis of all the bones has been reported. Most common site of extra pulmonary tuberculosis is the spine constituting about 50% of all the patients. Isolated tuberculosis of tubular bones consist of only 1% of all the skeletal tuberculosis. The mode of spread of the tubercular infection is due to the lodging of the tubercular emboli in the hair pin bends of the metaphysis. The final diagnosis is made by histopathological examination. Here, we present a case of isolated tubercular osteomyelitis of tibia without any articular involvement. A 12 year old male patient came to OPDwith complaint of pain just below the left knee since the past 3 months. On radiological evaluation, a well circumscribed lytic lesion involving the proximal transphyseal region of left tibia was seen (Fig. 1). On biopsy, the section showed granulation tissue with caseous necrosis and Langerhans giant cells (Fig. 2). This microscopic picture was highly suggestive of tuberculosis. The patient was started on anti-tubercular treatment using the first line anti tubercular a p o l l o m e d i c i n e 1 2 ( 2 0 1 5 ) 1 5 8 – 1 5 9