Osteomyelitis Tuberculosis in long bone mimicking bone malignancy: A case report

Osteomyelitis tuberculosis in developing countries is still a severe problem. Early diagnosis and treatment of osteomyelitis tuberculosis are very important because a delay in diagnosis can resemble malignancies. Osteomyelitis tuberculosis is often difficult to distinguish from a malignancy both clinically and radiologically. We present a rare case of a 10 years old boy with chief complaint was a lump around his left knee. He was treated earlier at a peripheral hospital as a malignancy process of bone, and referred to Dr. Soetomo Hospital, as a tertiary hospital, and decided to do an open biopsy in the operating room. On clinical examination was found lump and deformity with surrounding soft tissue swelling and limited ROM. On X-ray examination obtained pathological fractures and bone destruction in the distal femur with a lytic lesion on along the femur metadiaphysis without joint involvement and periosteal reaction proximally, from the examination it cannot be distinguished between osteomyelitis tuberculosis and malignancy. During the surgery, a voluminous amount of odourless pus with multiple septa surrounding the diaphysis. Pus culture and some of the tissue was taken to be examined by pathology that shows connective tissues infiltrated by inflammatory cells. Zeihl-Nielsen staining was done and obtained an image of acid-fast bacilli. Clinical and Radiological Features of osteomyelitis tuberculosis can mimic malignancy. The definitive diagnosis of tuberculosis osteomyelitis is usually made by CT-guided needle aspiration cytology and histologic examination using open biopsy. The latter has better sensitivity, especially if the acid-fast bacilli is obtained.