A report of two challenging cases of bone infection: Mycobacterium tuberculosis. How to manage?

Abstract

The incidence of bone tuberculosis is less than 5% of all tuberculosis cases. Furthermore, multifocal bone tuberculosis is uncommon, which rarely occurs without primary foci. It is difficult to diagnose, particularly if it is localized in both humeral heads. On the other hand, the isolated iliac bone tuberculosis is exceptional; it constitutes, also, a challenging diagnosis, which requires a high index of clinical suspicion and advanced investigations. Herein, we first report a case of multifocal tuberculosis of both humeral heads with no primary foci, and we secondarily report a case of isolated iliac bone tuberculosis. At last, however, the histological exam and polymerase chain reaction for the Mycobacterium tuberculosis complex are not always positives; they are mandatory as tests to ascertain the diagnosis.

Keywords: anti-bacillary; bone tuberculosis; polymerase chain reaction.

Figure 1

Radiographs of both shoulders (anterior-posterior views (a, b) lateral views (c, d) revealed lytic lesions and geodes in humeral heads (arrows)).

Figure 2

Computed tomography scan of the left shoulder showed intramedullary lytic lesions of the left humeral head.

Figure 3

Technetium 99-m bone scan demonstrated increased uptake at the skull, both clavicles and both humeral heads.

Figure 4

Radiograph of the pelvis showed the multiple circumference lytic lesions on the left iliac bone (arrows).

Figure 5

Computed tomography scan of the pelvis (without contrast (A), with contrast (B)) showed a fluid collection of the iliopsoas muscle (red arrows) along with osteitis and lytic lesions of the left iliac bone (yellow arrows).

Figure 6

The histopathological examination revealed chronic granulomatous inflammation with epithelioid and giant cells and central necrosis.