MULTIFOCAL SKELETAL TUBERCULOSIS IN AN IMMUNOCOMPETENT PATIENT - A CASE REPORT

Abstract

Tuberculosis is one of the most prevalent
bacterial infections in our country
and it is capable of affecting almost
every system in the human body. Skeletal
system is no exception to this. But
multifocal skeletal tuberculosis is quite a
rarity, more so in an immunocompetent
individual. We herewith report a 35 year
old female patient who presented with
complaints of pain over the inner aspect
of the right mid arm for the past 8 months
and swelling over the same site for 3
months, which was aggravated by limb
movements. On investigation, her ESR
was elevated. X-ray revealed an irregular
osteolytic lesion over the right humeral
diaphysis. With these findings, osteomyelitis
and malignancy were considered
as differential diagnoses. But bone scan
revealed increased tracer concentration
not only in the right humeral diaphysis,
but also over the left third metatarsal and
left radius. Immunosuppression was
ruled out and histopathological examination
of lesion showed tuberculous granuloma.
With this scenario the diagnosis
of multifocal skeletal tuberculosis was
made and ATT started, after which pain
and swelling decreased and the radiological
changes over the other sites improved.
This case is presented for its rarity, to emphasize
the role of bone scan in skeletal
screening and also to stress the need for a
high degree of suspicion of skeletal tuberculosis
while encountering such cases.
Keyword :Multifocal skeletal tuberculosis,
Bone scan, Immunocompetent, ATT, HPE.