Multifocal osteoarticular tuberculosis

Abstract

Multifocal osteoarticular tuberculosis is uncommonly reported despite its incidence of 7 to 10% in the Indian population. We describe the clinical features and management of 48 patients seen in the last nine years.

Tuberculous Osteomyelitis

“…8 The multifocal form is more common than solitary lesions 9 and, in a series of 13 children with histologically confirmed tuberculosis of bone, solitary cystic lesions were found in ten. 10 We detected nine solitary cystic lesions in six adults and three children (Figs 6 and 7).…”

Bone and joint tuberculosis

“…Multifocal bone TB is considered rare, accounting for 7-11 % of osteoarticular TB cases [17,39,45,48], but may be higher in undeveloped Asian and African countries, reaching an incidence of 15 %. Four to 6 bones or joints are usually affected, but as many as 19 different locations were described in a recent case report [30].…”

Tuberculosis of the Musculoskeletal System

“…The duration of symptoms range from days to months, and coexisting visceral disease is uncommon. 34,38 Abscess formation may occur, and sinuses are common. Notable features of a tuberculous sinus include bluish discoloration at the periphery, undermined edges, sero-sanguinous discharge, matted draining lymph nodes, and fixation to bone.…”

“…23,38 In children, intraosseous thrombosis may result in sequestration of the diaphysis, which may easily be confused with chronic bacterial osteomyelitis. 71 Unusual forms of skeletal tuberculosis include multiple cystic tuberculosis (one or more large, oval areas of rarefaction, children), 23,33,66 disseminated skeletal tuberculosis (multiple osseous and/or articular sites, compromised host), 1,2,34,51 closed multiple diaphysitis (swelling in forearms and legs in compromised children), 2 and tuberculous dactylitis (metacarpal or phalanx). Spina ventosa, a spindle shaped expansion with multiple layers of subperiostial new bone, occurs in the short tubular bones of the hands and feet (Fig.…”