cystic transphyseal tubercular osteomyelitis
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Cystic transphyseal tubercular osteomyelitis
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Cystic transphyseal tubercular osteomyelitis
Saurabh Sharma a, Vikram Khanna a,*, Abdul Rahim a, Raju Vaishya b
a Resident, Department of Orthopaedics, National Institute of Medical Sciences, Jaipur, Indiab Senior Consultant, Department Of Orthopaedics, Indraprastha Apollo Hospital, Delhi, India
a r t i c l e i n f o
Article history:
Received 25 March 2015
Accepted 9 April 2015
Available online xxx
* Corresponding author.E-mail address: 86.khanna@gmail.com (V
http://dx.doi.org/10.1016/j.apme.2015.04.0030976-0016/Copyright © 2015, Indraprastha M
Please cite this article in press as: Sharmadx.doi.org/10.1016/j.apme.2015.04.003
Fig. 1 e Radiological picture showing well circumscribed
cystic transphyseal lesion involving the upper third of
tibia.
Tubercular osteomyelitis of shaft without the joint involve-
ment is very rare. The most commonly associated symptoms
are pain and swelling in the affected bone. Diagnosis is often
delayed as radiologically it mimics Brodie's abscess, chronic
pyogenic osteomyelitis, cystic lesions, tumours and other
granulomatous conditions, either fungal or bacterial. Tuber-
culosis of all the bones has been reported. Most common site
of extra pulmonary tuberculosis is the spine constituting
about 50% of all the patients.1 Isolated tuberculosis of tubular
bones consist of only 1% of all the skeletal tuberculosis.2 The
mode of spread of the tubercular infection is due to the lod-
ging of the tubercular emboli in the hair pin bends of the
metaphysis. The final diagnosis is made by histopathological
examination.
Here, we present a case of isolated tubercular osteomyelitis
of tibia without any articular involvement. A 12 year old male
patient came to OPDwith complaint of pain just below the left
knee since the past 3 months. On radiological evaluation, a
well circumscribed lytic lesion involving the proximal trans-
physeal region of left tibia was seen (Fig 1). On biopsy, the
section showed granulation tissue with caseous necrosis and
Langerhans giant cells (Fig 2). This microscopic picture was
highly suggestive of tuberculosis. The patient was started on
anti-tubercular treatment using the first line anti tubercular
. Khanna).
edical Corporation Ltd. All rights reserved.
S, et al., Cystic transphyseal tubercular osteomyelitis, Apollo Medicine (2015), http://
Fig. 2 e Histopathological image showing granulation
tissue along with caseous necrosis and Langerhans Giant
cells. Highly suggestive of tuberculosis.
Learning points/take home message
� Tuberculous osteomyelitis which does not involve a
joint is uncommon and may fail to be diagnosed by an
orthopaedic surgeon.
� Doctors should keep this diagnosis in mind when they
see a clinical and radiological picture and should not
be misdiagnosed.
a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) 1e22
drugs and healing was seen on follow-up at 6 months. Hence,
a histopathological evaluation was crucial for making the
accurate diagnosis and starting an early, appropriate treat-
ment of the disease.
Please cite this article in press as: Sharma S, et al., Cystic transphdx.doi.org/10.1016/j.apme.2015.04.003
Conflicts of interest
All authors have none to declare.
r e f e r e n c e s
1. Bloch AB, Reider HL, Kelley GD, et al. The epidemiology oftuberculosis in the United States. Semin Respir Infect.1989;4:157e170.
2. Hsieh CK, Miltner LJ, Chang CP. Tuberculosis of the shaft of thelarge long bones of the extremities. J Bone Joint Surg Am.1934;16:545e563.
yseal tubercular osteomyelitis, Apollo Medicine (2015), http://
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