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Troublesome Tuberculosis: A Case Report on Multi-focal Tuberculous Osteomyelitis in An Immunocompetent Patient.
[pyomyositis]
Bone
and
joint
tuberculosis
is
a
chronic
debilitating
condition
that
leads
to
progressive
damage
and
even
deformity
of
joints
.
It
may
affect
one
or
multiple
sites
.
It
could
present
in
a
myriad
of
ways
which
may
result
in
an
incorrect
diagnosis
being
made
.
Common
misdiagnoses
include
seronegative
inflammatory
arthritis
,
septic
arthritis
,
malignancy
,
osteoporotic
fractures
and
mechanical
type
back
pain
.
It
was
initially
only
diagnosed
in
patients
with
previous
active
tuberculosis
or
latent
tuberculosis
.
However
,
in
recent
years
,
it
has
also
been
reported
in
patients
without
a
history
of
previous
tuberculosis
infection
.
Making
a
diagnosis
of
bone
and
joint
tuberculosis
is
challenging
.
As
the
symptoms
are
not
always
typical
,
a
delay
in
initiating
anti-
tuberculosis
treatment
is
not
uncommon
in
clinical
practice
.
Systemic
features
are
not
always
present
in
multi-drug
resistant
tuberculosis
of
joints
which
makes
the
diagnosis
even
more
challenging
.
Multi-drug
resistant
tuberculosis
is
an
increasingly
common
problem
.
It
is
not
only
limited
to
immunocompromised
patients
,
but
also
found
in
immunocompetent
patients
.
Multifocal
tuberculous
osteomyelitis
is
an
uncommon
condition
and
may
involve
any
bone
such
as
the
skull
,
ribs
,
long
bones
,
spine
and
phalanx
.
Tuberculous
pyomyositis
and
tuberculous
tenosynovitis
may
also
be
the
presenting
features
of
multifocal
tuberculosis
.
Identification
of
mycobacterium
tuberculosis
in
synovial
fluid
and
biopsy
,
tissue
culture
,
tissue
fluid
cytology
and
tissue
polymerase
chain
reaction
are
crucial
investigations
in
these
cases
.
As
the
presentation
of
extra
pulmonary
tuberculosis
can
be
very
variable
,
it
is
important
to
maintain
a
high
index
of
suspicion
.
The
diagnosis
and
therefore
treatment
may
be
expedited
using
a
clinically
directed
multidisciplinary
approach
.
Bone
and
joint
tuberculosis
;
Multi
focal
tuberculous
osteomyelitis
;
Extra
-
pulmonary
tuberculosis
;
Multi-drug
resistant
tuberculosis
;
Latent
tuberculosis
.
Diseases
Validation
Diseases presenting
"previous active tuberculosis"
symptom
pyomyositis
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