MULTIFOCAL SKELETAL TUBERCULOSIS IN AN IMMUNOCOMPETENT PATIENT - A CASE REPORT

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