Tuberculous Osteomyelitis Research Articles

Reevaluating Pediatric Osteomyelitis with Osteoarticular Tuberculosis: Addressing Diagnostic Delays and Improving Treatment Outcomes

Background: Pediatric osteoarticular tuberculosis (TB) remains a significant global health challenge, particularly in resource-limited settings, where delayed diagnosis and treatment frequently lead to severe long-term complications. Despite advancements in TB control, skeletal TB in children is often misdiagnosed due to its non-specific clinical presentation, contributing to poor outcomes such as joint deformities, growth disturbances, and chronic pain. The complexity of diagnosing osteoarticular TB is further exacerbated by the limited sensitivity of conventional diagnostic tools and the overlap with other musculoskeletal conditions. This study seeks to evaluate the impact of early detection and multidisciplinary management on treatment outcomes in pediatric patients with osteoarticular TB. Methods: A retrospective review was conducted at the Pediatric Orthopedics Department of the “Grigore Alexandrescu” Children’s Hospital in Romania from 2009 to 2023. Case data included clinical, imaging, and microbiological findings, and treatment outcomes in children aged 0–18 years diagnosed with tuberculous osteomyelitis. Results: The study identified varied clinical presentations, with delayed diagnosis often linked to misinterpretation of symptoms as non-TB infections. Multimodal diagnostic approaches combining imaging, microbiological testing, and histopathology improved diagnostic accuracy. Early surgical intervention alongside anti-TB therapy proved effective in reducing long-term complications. Conclusions: Timely, accurate diagnosis and multidisciplinary treatment are critical to improving outcomes in pediatric osteoarticular TB. Vaccination status and comprehensive diagnostic tools significantly influence disease progression and treatment success. The study underscores the need for enhanced screening and diagnostic methods to prevent delays in treatment.

Pink and Blue of Bones- A Histopathological Analysis of Bony Neoplasm in a Tertiary Hospital of Bihar

Background: Bone lesions have low incidence with diverse presentation and due to the presence of their limited studies it has become a challenging task to reach an accurate diagnosis. Aim and Objective: This study aims in studying variety of bony lesions observed clinically and histopathologically. Further categorizing into non neoplastic, tumour-like, benign tumour or malignant tumour and determining its correlation with the age and gender predisposition of these lesions. Materials and Methods: An ambispective study was executed in Pathology department , PMCH, Patna from May 2020 to April 2024 in which a total of 102 cases were collected. The necessary information for the retrospective analysis, such as the patient's age, sex, lesion location, and diagnosis, was obtained from the requisition form and the histopathology data kept in the department of pathology from May 2020 to May 2022. And for prospective study all the radiological proven bony lesions which were excised during period of May 2022 to April 2024 and were sent for histopathological examination were examined. Results: Non-neoplastic lesions were more common than neoplastic lesions among the 102 specimens that underwent histological examination (53 versus 49). With 21.5% of cases, tuberculous osteomyelitis was the most prevalent non-neoplastic lesion. The most common benign neoplastic lesion detected was a giant cell tumor of the bone (11.76%), while the most common malignant lesion found was osteosarcoma (2.94%). Conclusion: To improve patient management and diagnosis accuracy, it is advised to utilize clinical, radiological, and histological findings in an integrated manner.

Juvenile Tuberculous Osteomyelitis of the Mandible: A Rarity

Juvenile Tuberculous Osteomyelitis of the Mandible: A Rarity

Letter to the Editor: Isolated Tuberculous Osteomyelitis of the Femur Without Pulmonary.

Letter to the Editor: Isolated Tuberculous Osteomyelitis of the Femur Without Pulmonary.

Primary Mandibular Tuberculous Osteomyelitis Mimicking Ameloblastoma: A Case Report and Literature Review of Mandibular Tuberculous Osteomyelitis.

Primary tuberculous osteomyelitis involving the mandible represents less than 2% of skeletal locations. In this paper, we report a case of mandibular tuberculosis (TB) detected after histopathological analysis of the surgically resected specimen during surgical management of a suspected case of ameloblastoma. A 14-year-old male patient presented to us with history of right-sided chin swelling. The clinical examination revealed a swelling, involving right body and parasymphysis of mandible, measuring approximately 6 cm in length and 2 cm in width, extending from right lateral incisor till the first molar. Radiological scans revealed a large multiloculated osteolytic expansive lesion measuring 52 × 20 × 18 mm. Excision of the lesion was performed and reconstruction was done with iliac bone grafting. The histopathological findings revealed a granulomatous lesion, suggestive of tuberculous osteomyelitis. The patient was successfully treated with standard multidrug therapy. One year after completion of therapy, there were no signs of recurrence. Primary mandibular TB is an extremely rare entity. Its clinical presentation is not specific. Radiologically, TB has no characteristic appearance. The positive diagnosis is based on histology. Primary mandibular TB is rare and should be kept among differential diagnoses in susceptible population and in endemic areas.

Imaging of musculoskeletal tuberculosis.

Tuberculosis (TB) represents a major public health problem worldwide. Any tissue may be infected. Involvement of the musculoskeletal (MSK) system account for 1-3% of all tuberculous infections. MSK TB may manifest as tuberculous spondylitis, arthritis, osteomyelitis, and soft tissue infections. Although TB spondylitis may present with distinctive imaging features compared to pyogenic infections of the spine, the imaging semiology of extra-spinal TB infections is mostly nonspecific and may mimic other lesions. TB infections should therefore always be considered in the differential diagnosis, particularly in immunocompromised patients. The aim of this article is to review the imaging features of spinal and extra-spinal MSK TB. Magnetic resonance imaging is considered the modality of choice to make the diagnosis and to evaluate the extent of the disease.

Bilateral hand dactylitis: An unusual presentation of the great imitator: Tuberculosis.

The incidence of tuberculosis in developed countries has decreased over the years due to the use of effective tuberculosis drugs and improvements in socio-economic conditions. However, with the ease of global transport and increased travel to countries with high tuberculosis prevalence, the reduction in extrapulmonary tuberculosis cases has been less significant compared with the overall decrease in tuberculosis cases. Extrapulmonary tuberculosis can manifest in a variety of ways. Tuberculous dactylitis, a rare form of tuberculous osteomyelitis, was first described by Rankin in 1886. It mainly affects the short tubular bones in the hands and feet of children and is sometimes called 'spina ventosa'. A 42-year-old male patient initially presented to an external centre reporting swelling and pain in the hand joints of one year's duration. Despite one year of treatment with leflunomide and methylprednisolone (16 mg) and a history of methotrexate use during this period, he experienced no improvement. The patient's condition worsened after the start of sulfasalazine. Dermatological examination was performed due to the presence of haemorrhagic crusted papules and plaques on the ventral surface of both hands. A wound culture was taken, but no bacterial growth was observed. One week after the initial evaluation, the patient complained of persistent foul-smelling nasal discharge, which led to an evaluation by the infectious disease department. At this time, the Quantiferon test was positive. Mycobacterial culture on Days 1 and 3 showed growth of the Mycobacterium tuberculosis complex.

Isolated tuberculous osteomyelitis of mandibular condyle: A rare presentation unmasked by domestic violence

Tuberculosis (TB) is a granulomatous infectious disease caused by Mycobacterium tuberculosis. Tuberculosis can be pulmonary as well as extrapulmonary. Tubercular osteomyelitis accounts for about 10% of all cases of extrapulmonary tuberculosis. We present a case of a 40-year-old female with pain and swelling developing after a slap by her husband. The swelling was investigated including a biopsy and histopathological examination confirmed the diagnosis of tubercular osteomyelitis of the mandibular condyle.

Sternal Tuberculosis: About Two Senegalese Cases

Tuberculosis (TB) remains a major public health problem in resource-limited countries where it is endemic. Sternal TB is a rare entity. It accounts for less than 1% of tuberculous osteomyelitis.
 We report two cases of sternal TB occurring in two young Senegalese aged 21 and 23, who presented with inflammatory sternal swelling in the context of evening raise of temperature and weight loss. In both cases, Mycobacterium tuberculosis was detected in the pus specimen using the Genexpert® MTB/RIF test (Cepheid, California). In one case, a chest CT scan revealed lysis of the sternal manubrium. The patient's condition improved with anti-tuberculosis treatment and surgery.
 These cases, particularly in areas where tuberculosis is endemic, highlight the importance of considering tuberculosis as a possible cause of sternal tumefaction.

Pediatric Multidrug-Resistant Disseminated Tuberculosis Presenting as Small Finger Tuberculous Osteomyelitis: A Case Report.

We report a case in the United States of a 12-year-old girl with multidrug-resistant tuberculous (MDR-TB) osteomyelitis of the hand managed with surgical debridement and second-line anti-TB therapy. The disease course was complicated by dissemination and multifocal progression. Despite early intervention, multidrug resistance makes TB treatment challenging and facilitated progression to disseminated disease in this case. We review the difficulties in diagnosis and treatment of pediatric MDR-TB.

A Tuberculous Osteomyelitis Late Finding Affected The Fifth Metatarsal

Many studies have reported osteoarticular involvement of tuberculosis, but few cases of tuberculous osteomyelitis of the foot have been reported. We describe a case of tuberculous osteomyelitis affecting the fifth metatarsal bone in a 56- 56- year-old diabetic male patient and review the literature describing clinical manifestations, imaging aspects, and management of skeletal tuberculosis. A 56- year-old male patient presented with severe pain and swelling in his left leg for the past 6 months. He had no history of trauma. He had fever over his two months, had no cough, had lost weight, and had light sweats at night. His pain and swelling did not subside despite oral medication. The patient was diabetic. The patient also had radiating pain from his lower back to his left leg and numbness all over his lower back. Tuberculosis is a widespread problem in Indonesia. It can affect any part of the body. However, the feet are rarely affected. Tuberculosis is on the rise and it is important to recognize the less common symptoms of this disease to allow early diagnosis and successful treatment. In urban areas where TB prevalence is high, there may be no TB exposure or 'typical' symptoms and signs. Radiological features are non-specific, so indicators of high suspicion are required. Patients with suspected risk factors or tuberculosis should have a biopsy to make the diagnosis and start treatment.

Tuberculous Osteomyelitis Presenting as a Sternal Mass in Paediatric Patient: A Case Report

Background: Sternal tuberculosis is an uncommon form of extrapulmonary tuberculosis and it can be a diagnostic challenge for pediatricians.
 Case Presentation: We report the case of a young 14-year-old boy, who had a gradually increasing swelling of the sternum over the past 2 months preceded by weight loss, asthenia and night sweats. Radiological, histological, and microbiological investigations confirmed it as a case of sternal tuberculosis (TB). He was managed with surgical debridement during the sternal biopsy and quadruple antituberculosis therapy with good response.
 Discussion: Tuberculosis (TB) of sternum is one of the rarest forms of skeletal tuberculosis. The incidence of sternal tuberculosis has been calculated to be <1.5% amongst osteo-articular tuberculosis, with very few cases reported in infants. The diagnosis is based on histological and bacteriologic arguments.
 Conclusion: Tuberculous osteomyelitis of the sternum is a rare finding in children. Our aim is to increase awareness around atypical presentations and the uncommon involvement of the sternum in musculoskeletal tuberculosis.

Frontal Bone Tuberculous Osteomyelitis with Orbital Involvement: A Case Report

Frontal Bone Tuberculous Osteomyelitis with Orbital Involvement: A Case Report

Tuberculous Osteomyelitis of the Fifth Metatarsal Treated Using the Induced Membrane Technique: A Case Report

Tuberculous osteomyelitis of the foot, an uncommon and rare entity, accounts for <0.01% of all tuberculous localizations. Osteomyelitis secondary to tuberculosis is difficult to diagnose and treat, requiring a high suspicion index. We report a case of tuberculous osteomyelitis of the fifth metatarsal bone treated with the induced membrane technique. Here, we report the case of a 40-year-old woman with a history of immunosuppressive treatment presented with a complaint of painful swelling of the left foot. Radiographs showed osteolytic lesions of the fifth metatarsal bone. Initial biopsy suggested tuberculosis. She was surgically treated with the induced membrane technique. Histology confirmed tuberculous osteomyelitis and antituberculous treatment was initiated. Full weight-bearing was allowed after 8 months. At 24 months follow-up, all symptoms were resolved. The radiographs showed an integrated graft. In conclusion, the presence of osteolytic lesions on a plain film should rise high suspicious for a possible infection requiring biopsy, and if confirmed, mandates surgical debridement and reconstruction. The induced membrane technique offers a mean to treat infectious bone defects. Level of Evidence: Level 4.

Isolated calcaneal tuberculous osteomyelitis in a 13-year female: a diagnostic dilemma: rare case report and review of literature

Foot and ankle involvement in osteoarticular tuberculosis is uncommon and isolated calcaneal tubercular osteomyelitis of foot bones sparing nearby joints with an osteolytic defect is even more rare. Worsening of the disease can occur over a time involving nearby joints and small bones if diagnostic and therapeutic phase are delayed. We present a retrospective study of osteolytic variety of foot calcaneal bone tuberculosis. We present a case report of 13-year female with isolated osteolytic variety of calcaneal tuberculous osteomyelitis to highlight the clinical, radiological features and management challenges of the condition. Biopsy was done to confirm tissue diagnosis based on Gene Xpert, AFB staining, MGIT culture, and histopathology. Surgical intervention was done in form of debridement and sinus tract removal as a diagnostic and therapeutic purpose to prevent further involvement of a nearby joints and small bone with cystic destruction. Isolated calcaneal tubercular osteomyelitis cases are still found to be seen in our environment though considered a rare. When tuberculous pathology is limited to the isolated calcaneal bone sparing the other joints, the prognosis is better than in osteoarticular disease, as there is less deformity, and hence, less residual pain and disability.

A Rare Case of Tubercular Osteomyelitis of Maxilla: A Case Report.

Tuberculosis (TB) is a chronic granulomatous infection which primarily affects lungs. It is caused by Mycobacterium tuberculosis which was discovered by Dr Robert Koch. It can also affect other organs. Tuberculosis is a major cause of morbidity and mortality in developing countries. Early detection and initiation of antitubercular therapy are important in the management of TB. Extrapulmonary TB might not exhibit same features as pulmonary tuberculosis. Tuberculosis of maxilla is an extremely rare entity which can be misdiagnosed as carcinoma of maxillary sinus or other infectious conditions. We are presenting a case of tuberculous osteomyelitis of maxilla in a 14-year-old female who came with a discharging sinus over the right cheek. She underwent endoscopic debridement of sinuses and histopathological examination was suggestive of Koch's infection. Patient was further treated with antitubercular therapy and showed significant improvement at four weeks follow up.

A case of primary sternal tuberculosis mimicking a lytic bone tumor lesion of anterior chest wall

Primary tuberculous osteomyelitis of the sternum is a rare entity, accounting for only 1 to 3% of cases of osteoarticular tuberculosis (TB). It usually presents in young patients as a localized swelling, with a discharging sinus tract, and is accompanied by one of the systemic symptoms in the form of fever, night sweats, weight loss, or anorexia. Due to its atypical presentation, it poses a diagnostic challenge. We report the case of a 37-year-old female with primary sternal TB mimicking a lytic bone tumor lesion of the anterior chest wall.

Tuberculous osteomyelitis of maxilla: a rare case report

Tuberculosis, caused by Mycobacterium tuberculosis can affect almost any part of the human body. Tuberculous osteomyelitis is rare and constitutes less than 2% of the skeletal tuberculosis. Jaw involvement of the maxillary bone by tuberculous infection is extremely rare. Here we document a case of tuberculous osteomyelitis of maxilla who presented with history of multiple infraorbital abscesses. The case is unique due to its rarity and diagnostic dilemma.

Tuberculous osteomyelitis in body of mandible: A case report

Tuberculosis is chronic infectious disease and major cause of morbidity and mortality worldwide. It can affect any part of body, including oral cavity. Oral lesions of tuberculosis, though uncommon, have been observed in both primary and secondary stages of disease. This article presents case of tuberculosis in oral mucosa and mandible in 45 years old female. Involvement of oral cavity in TB is quite rare. Oral lesions seem to occur as chronic ulcers, nodular or granular areas. Most extra-pulmonary lesions represent secondary infections of primary lung infectious focus; therefore, early and accurate diagnosis is required for planning of best treatment and strategies to control disease.

Rare Presentation of Tuberculous Osteomyelitis of Mandibular Condyle Mimicking as Parotid Tumor: A Case Report.

Tuberculosis (TB) is a significant health problem and mortality in most developing countries. It is a chronic granulomatous disease caused by Mycobacterium tuberculosis and M. tuberculosis complex. It can be pulmonary form or Extra pulmonary form. Extrapulmonary tuberculosis involving temporomandibular joint is infrequent presentation of Skeletal TB. Here we present a rare case of extrapulmonary tuberculosis that was initially misdiagnosed as a parotid lesion due to atypical signs and symptoms and multiple in-conclusive FNAC reports. The final diagnosis was established by histopathological report.