Abstract
BackgroundExtrapulmonary tuberculosis is one of the great mimickers of medicine, and often masquerades as malignancy. As a result, patients may be referred to oncologists and surgeons for further evaluation and management, delaying the institution of appropriate anti-tuberculous drug therapy.Case presentationWe present the case of a 21 year old man with tuberculous osteomyelitis, who was referred to the Bone and Soft Tissue Sarcoma Service at our institution with a provisional diagnosis of malignancy. Further investigation revealed extensive retroperitoneal abdominal and pelvic lymphadenopathy. The recognition of certain patterns on imaging, and finally the isolation of Mycobacterium tuberculosis from tissue samples obtained under image guidance, enabled the correct diagnosis to be made.ConclusionThis case highlights the importance of remaining cognisant of the protean manifestations of extrapulmonary tuberculosis, and illustrates the advantage of a clinically directed multi-modality imaging approach to diagnosis.
Highlights
Extrapulmonary tuberculosis is one of the great mimickers of medicine, and often masquerades as malignancy
Skeletal tuberculosis can clinically simulate sarcoma, leading to the referral of patients suffering from this condition to oncologists and surgeons, delaying correct diagnosis and the institution of appropriate therapy
Whilst in the past this necessitated open surgical biopsy, tissue samples can be obtained with minimal invasion, under image-guidance. To highlight these issues we present the case of a young male with pain and swelling of the right elbow, referred to the Bone and Soft Tissue Sarcoma Service at our institution with a presumptive diagnosis of malignancy
Summary
There has been a significant rise in the prevalence of extrapulmonary tuberculosis in the developed world, owing to the emergence of multi-drug resistant strains of Mycobacterium tuberculosis and an increasing number of immune compromised individuals and immigrants from the developing world [1,2,3]. Whilst in the past this necessitated open surgical biopsy, tissue samples can be obtained with minimal invasion, under image-guidance To highlight these issues we present the case of a young male with pain and swelling of the right elbow, referred to the Bone and Soft Tissue Sarcoma Service at our institution with a presumptive diagnosis of malignancy. Initial investigation with plain XR of the right elbow joint revealed a joint effusion (Figure 1) As these findings were non-specific, further evaluation with different imaging modalities was undertaken. LFiimguitreed 3bone scan using Tc99m Limited bone scan using Tc99m This demonstrates diffusely increased radioactive tracer uptake by the right elbow, at the lateral epicondyle (dashed arrow) and the proximal ulna, as well as by the distal left radius (solid arrow).
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