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.

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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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