Skeletal tuberculosis is less common as compared to pulmonary tuberculosis. The incidence of Osteo articular tuberculosis is 1-3%. Of these, spine and hips involvement is more frequent. Long bones Diaphyseal tuberculosis incidence is extremely low even in endemic regions, but particularly in the Western countries. The paucity of specific nature of the symptoms usually results in a late diagnosis. The indolent nature of disease puts a great challenge to clinicians in diagnosing Diaphyseal tuberculosis of long bones accurately.
Differential diagnosis of a solitary lesion in the diaphysis of the long tubular bone includes Brodie’s abscess, cystic bone lesions, bone tumors, chronic pyogenic osteomyelitis or fungal/bacterial granulomatous lesions. Because of such varied clinical and radiological presentations, the diagnosis requires a high index of suspicion and usually establishes through biopsy and culture.
We reported this case to emphasize the unusual occurrence of long bones tubercles among immigrants to Western Countries as in our patient. A 25-year-old Man immigrant from Asia presented with chronic leg pain and swelling. He responded poorly to anti tuberculosis medical treatment due to noncompliance. His X-ray, CTscan and MRI Scans revealed a lytic lesion in lower shaft of tibia. Percutaneous CTguided biopsy of the lesion was done. Following curettage, tubercles osteomyelitis was diagnosed from obtained sample. Cementing of curettage cavity was done with newer version of antibiotic impregnated biodegradable cement. On Anti TB medical treatment, symptoms alleviated rapidly.
Talat Mahmood, Mujtaba Nassiri MCH, Osama Mohamed, Osman Yaqoub and Paul O'Grady