Osteoarticular Tuberculosis Mimicking Ewing’s Sarcoma in an Infant

Abstract

Osteoarticular tuberculosis (TB) of the bone is a rare form of TB, accounting for 1-5% of all extra-pulmonary TB cases worldwide. An otherwise healthy 11-month-old girl complained of swelling on her right wrist and avoidance of using it. She had no history of trauma, fever, weight loss, or other systemic symptoms. A mass on the dorsolateral side of the right wrist, measuring about 4x5cm, was found. In magnetic resonance imaging results, it was reported that there was a mass lesion of lytic character (Ewing’s sarcoma) with periost reaction. Excisional biopsy was performed; non-necrotizing granuloma was found. Mycobacteriological culture could not be performed since the tissue specimen was formalin-fixed and paraffin-embedded. The biopsy material obtained from the bone has no fresh tissue; the M. TB complex was determined upon mycobacteriological molecular examination of the tissue specimen on the waxed block. Therapy lasted for nine months. TB of the bone should be among the differential diagnoses even in the absence of pulmonary involvement and constitutional symptoms of TB. For diagnosis, it is essential to culture for the mycobacterial subtype by tissue biopsy and confirms the culture material by PCR.