Osteoarticular tuberculosis in infants: A diagnostic and management challenge

Abstract

Objectives: Musculoskeletal manifestations of tuberculosis in infants are rare and different both in etiopathological mechanism and clinical presentation. Radiological diagnosis of osteoarticular tuberculosis (TB) in infants is tricky due to the various differentials of a cystic lesion. Literature also mention it only in isolated case reports. We carried out this study with an aim to collate and study patterns of osteoarticlular TB in the appendicular skeleton and to highlight the difficulties in diagnosis and management. Material and Methods: We retrospectively reviewed the data at our hospital over the past 8 years. Microbiologically confirmed osteoarticular tuberculosis affecting appendicular skeleton in children below 1 year of age were included in the study. Cases with spine involvement were excluded. The delay to diagnosis from the onset of symptoms, the initial diagnosis and treatment given were noted. The resolution of radiological presentation and occurrence of deformities at the final follow up (atleast 1 year) were noted. Results: During the study period, 8 infants were diagnosed to have osteoarticular tuberculosis with median age at presentation of 8.7 months (range 3 to 12 months). Average duration of follow up was 4 years (range 1 to 8 years). Cystic, Erosive, infiltrative, spina ventosa and mortar pestle were the radiological appearances found. Three of the 8 cases were referred as suspected malignancy. All but one case were vaccinated with BCG. Curettage and anti-tubercular therapy (ATT) were the treatment in all cases. Three cases with a delay in diagnosis of more than 2 months, developed complications: 1 had limb length discrepancy (LLD) due to physeal involvement, 1 developed angular deformity and 1 child had perthe’s disease as a sequelae. Conclusion: Osteoarticular tuberculosis is an increasing possibility, shockingly, even in infancy and should be a differential in an endemic country like India. A delay to diagnosis of even 2 months of this condition can lead to devastating complications. Being mindful of the diagnosis and early treatment gives rewarding results.