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Background: Even though tuberculosis is a common disease among children in developing countries, tuberculous dactylitis is an uncommon form of Skeletal tuberculosis specially with involvement of both the hands and feet. Case Presentation: A one-and-a-half-year-old previously healthy female Ethiopian toddler presented to our pediatric outpatient clinic with a history of two-month duration of painful multiple swellings over both her hands and feet. The swelling involved the proximal phalanx of the left index finger, dorsum of the right hand, and dorsum of both feet over the first metatarsal bone. Physical examination, radiologic findings, and histopathology suggested tuberculous dactylitis. The patient was treated with anti-tuberculosis drugs for one year and she showed clinical and radiologic improvement and recovery. Conclusion: Tubercular dactylitis should be considered in the differential diagnosis of children from endemic areas presenting with bone and joint pain or swelling. Our experience of a twelve-month course of antitubercular treatment, which is in line with WHO recommendations, for skeletal tuberculosis, showed excellent outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Even though tuberculosis is a common disease among children in developing countries, tuberculous dactylitis is an uncommon form of Skeletal tuberculosis specially with involvement of both the hands and feet. Case Presentation A one-and-a-half-year-old previously healthy female Ethiopian toddler presented to our pediatric outpatient clinic with a history of two-month duration of painful multiple swellings over both her hands and feet. The swelling involved the proximal phalanx of the left index finger, dorsum of the right hand, and dorsum of both feet over the first metatarsal bone. Physical examination, radiologic findings, and histopathology suggested tuberculous dactylitis. The patient was treated with anti-tuberculosis drugs for one year and she showed clinical and radiologic improvement and recovery. Conclusion Tubercular dactylitis should be considered in the differential diagnosis of children from endemic areas presenting with bone and joint pain or swelling. Our experience of a twelve-month course of antitubercular treatment, which is in line with WHO recommendations, for skeletal tuberculosis, showed excellent outcomes.

This study presents a rare case of chronic multifocal tubercular osteomyelitis in a 13-year-old boy from Nepal, a high-burden country for tuberculosis (TB). He presented with chronic pain in the lower extremities and had no pre-existing comorbidities. The patient's clinical presentation, diagnostic process, and treatment plan are described. Multifocal skeletal TB, though infrequent, poses diagnostic challenges due to its variable manifestations. This case emphasizes the importance of considering TB in differential diagnoses, especially in endemic regions, necessitating a high index of suspicion. Early detection and treatment align with WHO's “End TB” strategy and Nepal's TB management guidelines, promoting improved outcomes in high-risk populations.

Extra-pulmonary tuberculosis (TB) of the musculoskeletal system usually manifests with non-specific clinical features, mimicking a variety of diseases. Diagnosis and treatment of spinal and extra-spinal musculoskeletal TB are often challenging. Imaging has an important role in detecting this disease, aiding diagnosis, identifying complications, and monitoring disease progression. Radiographs and magnetic resonance imaging are the key imaging modalities utilized. Radiologists should aim to be familiar with the spectrum of imaging features of TB affecting spinal and extra-spinal locations in the musculoskeletal system. [ABSTRACT FROM AUTHOR]

Abstract Background At present, skeletal tuberculosis (TB) diagnosis is mostly by histopathology, but the positivity rate is low. There is a need to develop new methods for the molecular identification of this disorder. Therefore, we aimed to investigate the clinical utility of quantitative PCR (qPCR)-based diagnosis of skeletal TB from formalin-fixed paraffin-embedded (FFPE) tissues and its comparative evaluation with acid-fast bacillus staining (AFS). Methods We detected Mycobacterium tuberculosis (M. tuberculosis/MTB) DNA using qPCR and AFS in FFPE tissue samples from 129 patients suspected of having skeletal TB. The sensitivity, specificity as well as area under the curve (AUC) of qPCR and AFS were calculated. Meanwhile, some factors potentially affecting qPCR and AFS results were investigated. Results Overall, qPCR outperformed AFS in detecting M. tuberculosis. The AUC of qPCR was higher than that of AFS (0.744 vs.0.561, p

The incidence of skeletal tuberculosis is about 1%-5% of all tuberculous infections. The most common sites are the spine, hip, knee, foot, elbow, hand, and shoulder, whereas the sternum, ribs, sternoclavicular joint, and calvaria are rarely affected. Because of the emergence of skeletal tuberculosis in therapeutic management, radiologists need to be aware of the imaging findings in pulmonary and extrapulmonary tuberculosis. Conventional X-ray plays an important role in diagnosing pulmonary and skeletal tuberculosis. Tuberculosis is known as the ‘great mimicker’, however, thus computed tomography and magnetic resonance imaging may provide additional details that assist the radiologist in distinguishing this tubercular infection from others. We report the case of a young male patient with skeletal tuberculosis who presented with general weakness, paraplegia, and a calvarial mass.

Multifocal extensive spinal and extraspinal tuberculosis is very rare. So far, fewer than 10 cases have been reported. We hereby report two such cases to highlight their rarity, the diagnostic and therapeutic challenges they presented, and the overall prognosis of the condition. The two patients (a 19-year-old woman and another 20-year-old woman) had multifocal extensive tuberculosis involving spine and appendicular skeleton with neurological deficit. Both patients presented with back and neck pain and gradual neurological deficit. The insidious onset and malignancy-like spread pattern mimicked neoplasm. After thorough investigations with magnetic resonance imaging, positron emission tomography scan, and biopsy, antitubercular drug therapy was started, and debridement and fixation were done for significant thoracic and cervical vertebral lesions, respectively. Both patients showed excellent neurological recovery after the procedure. Early surgical treatment of the cases with large abscesses helped provide decompression and stabilization and prevented neurological deterioration and deformity. In patients with noncontiguous spinal tuberculosis, high percentage of surgical treatment may be required due to the aggressive behavior of the disease. [ABSTRACT FROM AUTHOR]

Osteoarticular tuberculosis of the wrist is a very rare subset of skeletal Tuberculosis. Diagnosing the tuberculosis wrist in its early stage poses a major challenge to the clinicians because of its atypical and vague presentations and a close resemblance to many relatively benign pathologies. Clinicians from developed parts of the world having less exposure to the myriad forms of osteoarticular tuberculosis are more likely to miss it. We hereby report one such case who presented with wrist pain of short duration, which after thorough examination and investigations, turned out to be tuberculous. It was successfully managed with anti-tuberculosis drugs alone without any debridement or synovectomy. Familiarity with the clinical profile of this entity, in its early stages, is valuable for primary care physicians, rheumatologists, internal medicine specialists, and orthopaedicians alike, who may confuse it with one of the many more common inflammatory, degenerative, or traumatic causes of wrist pain. Within normal range or near normal erythrocyte sedimentation rate and C-reactive protein, and normal looking X-ray does not preclude the diagnosis of tuberculosis wrist. The role of a high index of suspicion and a low threshold for getting higher radiological investigation like MRI in non-responding cases of wrist joint pain cannot be overstated.

Osteoarticular tuberculosis of the wrist is a very rare subset of skeletal Tuberculosis. Diagnosing the tuberculosis wrist in its early stage poses a major challenge to the clinicians because of its atypical and vague presentations and a close resemblance to many relatively benign pathologies. Clinicians from developed parts of the world having less exposure to the myriad forms of osteoarticular tuberculosis are more likely to miss it. We hereby report one such case who presented with wrist pain of short duration, which after thorough examination and investigations, turned out to be tuberculous. It was successfully managed with anti-tuberculosis drugs alone without any debridement or synovectomy. Familiarity with the clinical profile of this entity, in its early stages, is valuable for primary care physicians, rheumatologists, internal medicine specialists, and orthopaedicians alike, who may confuse it with one of the many more common inflammatory, degenerative, or traumatic causes of wrist pain. Within normal range or near normal erythrocyte sedimentation rate and C-reactive protein, and normal looking X-ray does not preclude the diagnosis of tuberculosis wrist. The role of a high index of suspicion and a low threshold for getting higher radiological investigation like MRI in non-responding cases of wrist joint pain cannot be overstated. [ABSTRACT FROM AUTHOR]

Background: At present, skeletal tuberculosis (TB) diagnosis is mostly by histopathology, but the positivity rate is low. There is a need to develop new methods for the molecular identification of this disorder. Therefore, we aimed to investigate the clinical utility of quantitative PCR (qPCR)-based diagnosis of skeletal TB from formalin-fixed paraffin-embedded (FFPE) tissues and its comparative evaluation with acid-fast bacillus staining (AFS).Methods: We detected Mycobacterium tuberculosis (M. tuberculosis/MTB) DNA using qPCR and AFS in FFPE tissue samples from 129 patients suspected of having skeletal TB. The sensitivity, specificity as well as area under the curve (AUC) of qPCR and AFS were calculated. Meanwhile, some factors potentially affecting qPCR and AFS results were investigated.Results: Overall, qPCR outperformed AFS in detecting M. tuberculosis. The AUC of qPCR was higher than that of AFS (0.744 vs.0.561, p < 0.001). Furthermore, decalcification of bone tissues did not affect the sensitivity and specificity of qPCR tests. Whereas it impacted the performance of AFS, decalcification increased AFS's specificity and decreased its sensitivity (p < 0.05). Moreover, qPCR had a significantly larger AUC than AFS in decalcified and non-decalcified groups (0.735/0.756 vs. 0.582/0.534, p < 0.001) respectively. Similarly, the AUC of PCR was more extensive than that of AFS regardless of skeletal TB patients with concomitant pulmonary TB or not (0.929 vs. 0.762; 0.688 vs. 0.524, p < 0.01).Conclusions: Our data demonstrate that qPCR offers superior accuracy for the detection of mycobacteria in FFPE tissues compared to traditional AFS, indicating its clinical value in osteoarticular TB diagnosis. [ABSTRACT FROM AUTHOR]

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Tuberculosis (TB) of the musculoskeletal system is not an uncommon clinical condition. Multifocal osseous involvement is often rare and difficult to recognize. Because of the diverse and atypical clinical manifestations, it is easily misdiagnosed in many situations. The present study reports a case of multifocal skeletal TB masquerading as septic arthritis of the interphalangeal joint of the thumb. Because of the high prevalence of TB in developing countries, chronic osteoarticular infective lesions are to be considered as TB unless proved otherwise. The importance of clinical suspicion, systematic investigation, and the role of a biopsy in the diagnosis of skeletal TB is emphasized in this study.

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (MTB). It spreads from one person to the another through the air while coughing, spitting, speaking or sneezing. TB most commonly affects lungs but it can affect any organ system. Diagnosis of TB is made on the basis of microbiological evidence of MTB on microscopic examination, cultures and chest X-rays. Poncet's disease is a separate entity in which joints are involved in the form of joint pain and swelling without any microbiological evidence of MTB. It usually occurs in the background setting of pulmonary TB. This case focuses on importance of considering Poncet's disease in the differential diagnosis of paediatric polyarticular arthritis in TB endemic regions or if there is a history suggestive of TB exposure and infection. [ABSTRACT FROM AUTHOR]

ABSTRACT Tuberculosis of the skull or calvarial tuberculosis (CTB) is rare. The literature until 2019 reported less than 60 cases of CTB in childhood. The authors describe two patients with CTB associated with other manifestations of TB, such as: spine and rib injuries, peripheral adenopathy, hepatic and splenic involvement who improved with chemotherapy. The patients were a four-year-old and an eight-year-old child, whose diagnoses were confirmed by histopathological, bacteriological or molecular investigation. Both were not infected with the human immunodeficiency virus (HIV) and did not need orthopedic treatment.

Background: The incidence of tuberculosis (TB) has increased in recent years in both developed and developing countries. Skeletal tuberculosis occurs in approximately 1% of patients with tuberculosis. The present study aimed to evaluate the epidemiology of skeletal tuberculosis in Golestan province in northeastern Iran during 2005-2014. Methods: In the present retrospective study, the epidemiology of skeletal tuberculosis was studied in 229 skeletal tuberculosis patients who were diagnosed during 2005-2014. The prevalence rate of skeletal TB has been reported according to demographic and clinical features. Results: Over the 10-year period of this study, 229 known skeletal TB cases were identified in which 56.3% were male. The mean age of the patients was 44.0±17.7 (range 7-87). All of the patients were new cases. Most of the patients (56.8%) were from the rural areas and most were diagnosed by the private healthcare system (63.8%). The highest rate of skeletal TB was seen in 2013 (15.3%). Spinal TB (81.2%) scored the highest rate and pain (96.9%) was the most prevalent symptom of skeletal TB. Conclusion: The findings suggest that skeletal tuberculosis in northeastern Iran should always be considered as a differential diagnosis for fever and pain on the spinal column. Due to the high level of tuberculosis in the Golestan province (Iran), further research on continued awareness of skeletal TB is stressed.

Skeletal tuberculosis (TB) is rare, accounting for 1%–2% of all cases of TB with multifocal involvement being rarer. Bones most commonly involved are the spine, joints, shoulder girdle, sternum, pelvis, ribs, skull, and orbit. We hereby report such multifocal bone TB in a 58-year-old-male who presented with complaints of pelvic pain of 2 months' duration. Radiograph of pelvis showed lytic lesions left ilium. A differential diagnosis of multiple myeloma and secondary bone metastasis was initially thought of. Computed tomography scan, magnetic resonance imaging, and bone scan pointed toward metastatic bone involvement. Metastatic workup with positron emission tomography scan and myeloma workup were negative. Biopsy from the lytic bony lesion was done which revealed TB with Ziehl–Neelsen staining positive for acid-fast bacilli. He was diagnosed as a case of primary bone TB and was commenced on antitubercular therapy to which he responded significantly. This case is being reported to highlight its extreme rarity, the diagnostic and therapeutic challenges it presented, and the overall prognosis of this condition.

Skeletal tuberculosis (TB) accounts for 1%–2% of all types of TB. The most common form of skeletal TB is Pott's disease, a disease of the spine; this entity comprises approximately half of skeletal TB cases. Tuberculous cold abscess can present as swelling on the back usually originating from the thoracic spine. Herewith is presented a rare case presentation of a patient who presented with a vertical swelling over the paraspinal region who on evaluation was found to have a cold abscess of tuberculous etiology arising from the ribs and tracking down the paraspinal region. This case is presented here for its rarity being a primary chest wall TB with no pulmonary involvement.

Tuberculosis of the skull or calvarial tuberculosis (CTB) is rare. The literature until 2019 reported less than 60 cases of CTB in childhood. The authors describe two patients with CTB associated with other manifestations of TB, such as: spine and rib injuries, peripheral adenopathy, hepatic and splenic involvement who improved with chemotherapy. The patients were a four-year-old and an eight-year-old child, whose diagnoses were confirmed by histopathological, bacteriological or molecular investigation. Both were not infected with the human immunodeficiency virus (HIV) and did not need orthopedic treatment. [ABSTRACT FROM AUTHOR]

Two anthropological collections of the 8–9th century AD from the forest-steppe area of the southern Eastern Europe has been the subject of analysis of the osteo-articular alterations concerning tuberculosis related lesions. According to archaeological data, the Mayaki and Dmitrievka groups are from the territory of Khazar Khaganate, which is well-known by historical data. It was a traditional population with settled pastoral farming. There were studied 292 adult human remains by macroscopic morphological and radiological methods. The completeness of the skeletons could have been better due to the intentional selection of their parts for the museum funds, so there were limitations for the differential diagnosis of TB by morphological criteria. In general, 31 individuals (20 men, 11 women) were marked as possible candidates with skeletal TB. The number of skeletons with possible specific infections from the two series is comparable, but according to sex distribution, there are some significant differences. If in the Dmitrievka group, there was approximately the same distribution of the number of cases of possible infected men and women; in the Mayaki group then there was a significant difference in the prevalence of the male sample. Various reasons can explain the observed differences. Firstly, we cannot rule out an error in the diagnosis of tuberculosis only by morphological methods since the preservation of the skeletons leaves much to be desired. Secondly, as it is known, only a few percent of tuberculosis patients show skeletal alterations, so the direct quantitative comparison cannot be adequate in paleopathological studies. The ambiguity of morphological criteria, particularly for destructive lesions of bone other than vertebrae, does not allow asserting that all identified cases result from TB. However, the results of differential diagnosis can underline that at least half of the skeletons have skeletal alterations most likely related to TB. The final analysis of the remains by aDNA methods will permit more certain confirmation of the diagnosis. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) has long been a major scourge of humankind. Paleopathological and paleomicrobiological studies have revealed the past presence of the disease on a large spatial and temporal scale. The antiquity of the disease has extensively been studied in the Carpathian Basin, given its dynamic population and cultural changes since prehistory. These studies, however, have mainly focused on the populations living during the Common Era. The aim of this paper is to present the published and the recently discovered cases of prehistoric TB, from the Neolithic (6000–4500/4400 BCE) to the Bronze Age (2600/2500-800 BCE) Central Carpathian Basin (Hungary). We summarize 18 published cases and present new cases dating to the Neolithic period and introduce 3 newly discovered Bronze Age cases of TB. Despite extensive research, TB has not yet been identified from the Copper and Iron Ages in the Carpathian Basin. Considering the state of TB research, and supplemented by our prehistoric dataset, the spatio-temporal pattern of the disease can be further elucidated, thus advancing future molecular and paleopathological studies. Our dataset offers comprehensive spatial and temporal information on the spread of the disease in the Carpathian Basin, along with a detailed biological profile of the demonstrated cases and extensive paleopathological descriptions of the observed lesions, complemented by photographic evidence. This invaluable resource paves the way for enhanced understanding and progress in the field. [ABSTRACT FROM AUTHOR]

The causative agent of tuberculosis is still a widespread pathogen, which caused the death of ca. 1.6 million people globally in 2021. The paleopathological study of human remains revealed the antiquity of the disease and its continuous presence throughout the history of humankind. The Carpathian Basin has always been a biocultural melting pot, since it has seen several migrations over the centuries, and served as a location of admixture and interaction for numerous populations of different cultures. Thus, this geographical territory is ideal for the examination of the coevolutionary processes of hosts and their pathogens. We aimed to reveal the spatial and temporal distribution of tuberculosis cases excavated inside the borders of Hungary between the 2nd and 16th centuries CE. We established a comprehensive database by collecting 114 already published cases and introducing 39 new cases. The involved cases include those that have been confirmed by different molecular methods, as well as possible infections that were identified based on the presence of macromorphological and radiological alterations. The progress of future molecular and paleopathological studies can be facilitated by our dataset, as it presents spatial and temporal information concerning the spread of the disease in the Carpathian Basin, as well as the biological profile and detailed paleopathological description of lesions illustrated by photo- and radiographs. • Comprehensive database on 153 tuberculosis cases (2nd–16th centuries). • Detailed description of 39 new cases illustrated by photo- and radiographic images. • Brief review of the population history of the Carpatian-Basin between the 2nd-16th CE. [ABSTRACT FROM AUTHOR]

Back ground: Skeletal tuberculosis could lead to disabling and painful states of bones and joints affecting the quality of life. Objective: To study the clinico-social profiles of Skeletal Tuberculosis (SKTb) in Karimnagar district of Telangana state Methods: A hospital based cross-sectional study was carried out using purposive sampling. Three doctors collected the data from 100 patients suffering from SKTb using a pretested questionnaire on the social variables, clinical presentations and probable indicators and analyzed. Group talks were conducted with patients for imparting necessary heath knowledge regarding prevention of further complications. Results: Overall prevalence of SKTb was about 33%. SKTb was more seen among males (58%). Tuberculosis of Spine was the leading bone disease (52%) followed by that of knee (22%) and hip (16%). Mean age affected was 45-65 years (39%).SKTb affected largely lower and middle class people (90%), less educated people (92%) non-executives (92%) Majority of patients (62%) were tuberculin positive .One third of patients (33%) had past history of pulmonary tuberculosis. Thirty percent of patients gave family history of tuberculosis. Conclusion: SKTb was found to be related with the past history of pulmonary tuberculosis, family history, and tuberculin positivity. Intensifying health education about these probable indicators is worth trying among the patients' families and people at risk to prevent SKTb.

Although skeletal tuberculosis is most common form of extra pulmonary infection, tuberculosis of the shoulder is a rare disorder with male predominance. Tuberculous involvement of glenoid with relative sparing of humerus is further rare presentation. A young man presented to outpatient clinic with long standing history of gradual onset, progressive pain and limited range of active movements involving right shoulder joint. Clinical examination revealed fullness in anterior axilla with palpable axillary lymphadenopathy. The laboratory examination revealed raised ESR and lymphocytosis. MRI findings revealed bony destruction involving glenoid with extensive enhancing synovial proliferation and cold abscess formation in joint, focal involvement of humeral head and axillary lymphadenopathy. The patient was started on antitubercular treatment and responded well till follow-up was done.

Skeletal tuberculosis (TB) is usually present in 1%–3% of active TB patients. Those with altered immunity have an increased of Skeletal TB. The most commonly involved sites are hip (20%), knee (10%), ankle and foot (5%), and shoulder (1%), and the most common forms of presentation are arthritis, spondylitis, and osteomyelitis. Tuberculous pathological fracture is a rare presentation, and only three cases have been reported in literature. We present a case of a 4½-month-old boy with a nontraumatic fracture of the humerus secondary to TB. Our patient was started on a four-drug regimen consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide and advised immunodeficiency workup.

Background: The incidence of tuberculosis (TB) has increased in recent years in both developed and developing countries. Skeletal tuberculosis occurs in approximately 1% of patients with tuberculosis. The present study aimed to evaluate the epidemiology of skeletal tuberculosis in Golestan province in northeastern Iran during 2005-2014. Methods: In the present retrospective study, the epidemiology of skeletal tuberculosis was studied in 229 skeletal tuberculosis patients who were diagnosed during 2005-2014. The prevalence rate of skeletal TB has been reported according to demographic and clinical features. Results: Over the 10-year period of this study, 229 known skeletal TB cases were identified in which 56.3% were male. The mean age of the patients was 44.0±17.7 (range 7-87). All of the patients were new cases. Most of the patients (56.8%) were from the rural areas and most were diagnosed by the private healthcare system (63.8%). The highest rate of skeletal TB was seen in 2013 (15.3%). Spinal TB (81.2%) scored the highest rate and pain (96.9%) was the most prevalent symptom of skeletal TB. Conclusion: The findings suggest that skeletal tuberculosis in northeastern Iran should always be considered as a differential diagnosis for fever and pain on the spinal column. Due to the high level of tuberculosis in the Golestan province (Iran), further research on continued awareness of skeletal TB is stressed. [ABSTRACT FROM AUTHOR]

Multifocal skeletal involvement is exceptional, constituting

Clear skeletal evidence of prehistoric tuberculosis (TB) is rare, especially in children. We describe and differentially diagnose the pathological changes displayed by a five-year-old child, Pollera 21 (PO21) dated to the Middle Neolithic of Liguria (Italy), or 5740 ± 30 BP (Beta-409341; 6635–6453 cal BP, 2σ, OxCal 4.2). PO21 shows a number of osteoarticular lesions, mainly of a lytic nature with very little bone proliferation: the vertebral column, the shoulder and pelvic girdles, and the ribcage are involved. Given the nature and pattern of the lesions, we propose a diagnosis of multifocal (or multiple) bone TB. Attempts to detect TB aDNA through molecular analysis gave negative results, but this alone is not sufficient to prove that PO21 was not infected with TB. The lesions observed in PO21 share similarities with other published evidence, such as spinal and joint involvement, and disseminated cyst-like lesions. Conversely, PO21 does not show diffuse bone deposition, such as hypertrophic osteoarthropathy (HOA) or endocranial modifications such as serpens endocrania symmetrica (SES). PO21 adds to our knowledge of patterns of TB manifestation in archaeological skeletal remains, which is especially important considering the variability in types and patterns of osteoarticular lesions seen today in people with TB. [ABSTRACT FROM AUTHOR]

Skeletal tuberculosis (TB) accounts for 1%–2% of all types of TB. The most common form of skeletal TB is Pott's disease, a disease of the spine; this entity comprises approximately half of skeletal TB cases. Tuberculous cold abscess can present as swelling on the back usually originating from the thoracic spine. Herewith is presented a rare case presentation of a patient who presented with a vertical swelling over the paraspinal region who on evaluation was found to have a cold abscess of tuberculous etiology arising from the ribs and tracking down the paraspinal region. This case is presented here for its rarity being a primary chest wall TB with no pulmonary involvement. [ABSTRACT FROM AUTHOR]

can present extraordinarily as a non-resoluting inflammatory pathology or can even mimic as malignancy especially sarcomatous or metastatic deposits. It sometimes can be diagnostically challenging for both the treating clinician and pathologist. The present case report documents a 47-yearold male agricultural worker who was immunocompetent and showed no signs and symptoms of pulmonary tuberculosis. His intradermal tuberculin sensitivity test was also negative. He presented with non-union of right tibia shaft fracture. A modified technique was employed i.e. of doing Fine needle aspiration cytology (FNAC) with Sahli’s bone marrow aspiration needle from the non-united ends of the tibia shaft. This led to the documentation of caseating granulomas and later on positive Ziehl-Neelsen (ZN) staining confirmed the diagnosis of EPTB. The case is worth reporting because of the unusual presentation of EPTB as non union with involvement of marrow and how a systemic approach with cytology and microbiology can lead to a quick and confirmative diagnosis, thus avoiding open biopsies which are not only expensive for the patient but are also associated with a share of morbidity.

Tuberculosis, one of the oldest diseases known to affect humans is caused by the bacteria mycobacterium tuberculosis. The disease usually affects the lungs, although, in up to one third of cases, other organs are involved. Metastatic tuberculosis abscess is a rare form of skin tuberculosis. It is characterized by nodule and abscess formation throughout the body after hematogenous spread of mycobacterium tuberculosis from a primary focus during a period of impaired immunity. Tuberculosis osteomyelitis is also a rare form of extrapulmonary tuberculosis in pediatric age group. Skeletal tuberculosis pathogenesis is related to reactivation of hematogenous foci or spread from adjacent paravertebral lymph nodes. Weight-bearing joints are affected most commonly. Bilateral hand and foot bone involvement is rarely reported. We present a five-year-old girl with two very rare presentations of the disease such as osteomyelitis and metastatic skin abscess.

The analysis of the skeletons of past human populations provides some of the best biological data regarding the history of significant diseases such as tuberculosis. The purpose of this study is to present the pathological alterations of the bones in this disease deriving from the ancient time of the territory of the Hungarian Great Plain on the basis of the earlier references and new cases. The bone changes in tuberculosis were mainly manifested in the vertebrae and less frequently in the hip, however, further alterations were observed on the surface of the endocranium and the ribs.

Tuberculosis (TB) of the musculoskeletal system is a rare clinical condition. Multifocal bone involvement is extremely rare and difficult to recognize. Thus, due to the diverse and atypical clinical manifestations of multifocal skeletal TB, the disease is easy to misdiagnose. In the present study, a rare case of atypical disseminated multifocal skeletal TB was reported, which exhibited uncommon findings in radiological images that were more suggestive of a hematological malignancy or metastatic disease. In conclusion, the diagnosis of this condition by conventional diagnostic methods is challenging. The importance of CT-guided needle biopsy and open biopsy in the diagnosis of skeletal TB was emphasized. [ABSTRACT FROM AUTHOR]

Abstract Background Disseminated tuberculosis (TB) or miliary TB is defined as lymphohematogenous dissemination of Mycobacterium tuberculosis bacilli, which may then affect virtually any organ system. The multiple organ involvement in disseminated TB can mimic metastatic cancer and can make the diagnosis challenging. False negatives are common therefore repeating microbiologic and histologic samples is essential. Case report We report the case of a young immunocompetent patient presenting with multiple atypical extra-pulmonary TB involvement. The patient presented with pulmonary, pleural, bilateral testicular and multiple bone involvement including calcanerium abscesses. These lesions were initially described as metastasis by the radiologist. Therefore lymphoma and metastatic testicular cancer as well as TB were high on the differential in this young foreign-born male. Pleural, broncho-alveolar lavage, bone marrow and cerebrospinal fluid acid-fast bacilli smear and microbiologic culture were all negative. However the histologic examination of the trans -bronchial biopsy and pleural biopsy showed necrotizing granuloma and helped to narrow down the diagnosis. The patient improved with RIPE therapy. Conclusion This case illustrates the diagnostic difficulty of disseminated TB with atypical organ involvement. Culture is the gold standard for diagnosing TB but is a long process and with 23% of culture negative TB in the United-States, the diagnosis sometimes relies on thoroughly ruling-out differential diagnosis and histologic examination. [ABSTRACT FROM AUTHOR]

Background: Sacroiliac tuberculosis is a rare condition for which early diagnosis and effective management frequently proves challenging. This report describes a case that was initially overlooked due to its presentation and unreported constitutional symptoms. Aim: To alert clinicians about skeletal tuberculosis, an often neglected diagnostic differential, which requires a high index of clinical suspicion, especially for patients from endemic areas. Findings: This patient's presentation (sports injury) and unreported constitutional symptoms resulted in a delay in the diagnosis and initial institution of treatment. Implications: This report illustrates the importance of specifically asking about constitutional symptoms, even in sports injury settings and being mindful of infectious diseases or other chronic medical conditions, which may masquerade as common sports injuries. [ABSTRACT FROM AUTHOR]