Primary iliac bone tuberculosis: a case report

Abstract

Tuberculosis (TB) remains one of the world's leading causes of morbidity and mortality. It occurs in both pulmonary and extra-pulmonary forms. Primary iliac bone TB remains a rare clinical entity, even in endemic areas. The diagnosis of the disease can be challenging due to its similarity to other bone diseases. We report a rare case of primary iliac bone TB in a 63-year-old patient who was on peritoneal dialysis and had a medical history of hypertension and type II diabetes, which was complicated by diabetic retinopathy and diabetic kidney disease. Magnetic resonance imaging revealed osteomyelitis in the iliac bone, while real-time polymerase chain reaction using the GeneXpert^® system on a gluteal collection sample confirmed the diagnosis of TB. The integration of advanced molecular tools, such as GeneXpert^®, represents significant progress, enabling rapid and accurate diagnosis of TB and facilitating early initiation of treatment.

Keywords: GeneXpert®; peritoneal dialysis; primary iliac bone tuberculosis.

Fig. 1.. Axial pelvic T1-weighted MRI sequences after gadolinium injection show enhanced intramedullary foci. The red arrow indicates a hyperintense lesion in the right greater trochanter and metaphysis, while the blue arrow highlights a similar lesion in the left iliac bone, both demonstrating post-contrast enhancement consistent with foci of osteomyelitis.

Fig. 2.. Sample obtained by puncture of the gluteal collection.

Fig. 3.. Ultrasound of the soft tissues showing a heterogeneous gluteal collection within the left gluteal muscle, measuring 5.08 cm × 4.65 cm.