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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 6  |  Issue : 2  |  Page : 191-192

Isolated lytic bone lesion in tuberculosis


Department of General Medicine, MES Medical College, Kerala, India

Date of Web Publication19-May-2017

Correspondence Address:
Mansoor C Abdulla
Department of General Medicine, MES Medical College, Perinthalmanna - 679 338, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmy.ijmy_62_17

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  Abstract 

Causes of lytic bone lesions include benign, malignant, and infectious processes. Lytic lesions due to tuberculosis (TB) may closely mimic those due to tumors such as bone cyst, osteoblastoma, osteosarcoma, and metastatic bone disease radiologically. Histopathology and culture help in definitive diagnosis and prompt management. We describe an immunocompetent patient with isolated lytic bone lesion in the distal part of ulna due to TB to make the readers aware of such unusual presentations of TB.

Keywords: Extra pulmonary tuberculosis, lytic bone lesion, tuberculosis


How to cite this article:
Abdulla MC. Isolated lytic bone lesion in tuberculosis. Int J Mycobacteriol 2017;6:191-2

How to cite this URL:
Abdulla MC. Isolated lytic bone lesion in tuberculosis. Int J Mycobacteriol [serial online] 2017 [cited 2019 Sep 22];6:191-2. Available from: http://www.ijmyco.org/text.asp?2017/6/2/191/206611


  Introduction Top


Tuberculosis (TB) can cause isolated lytic bone lesion even in the absence of pulmonary symptoms or known exposure and should be differentiated from other causes. The nonspecific, often indolent, clinical presentation of extraspinal musculoskeletal TB, together with its low prevalence and the low index of suspicion among clinicians, may result in delay in the diagnosis.


  Case Report Top


A 25-year-old otherwise healthy woman presented with pain in the left wrist for 1 month. She had no history of significant weight loss, no sick contacts, and no history of addictions. On examination, there was tenderness over the distal part of the left ulna. Hemoglobin was 11.5 g/dl, total leukocyte count 9400/ml with normal differential, platelet count 230,000/μl, and erythrocyte sedimentation rate 87 mm in 1 h. Blood chemistries were normal. Chest X-ray was normal. X-ray left wrist showed a lytic lesion in the distal part of ulna ([Figure 1] Panel A, arrow). Magnetic resonance imaging of the left wrist showed focal lytic lesion with cortical destruction, periosteal reaction, and enhancing soft tissue component in the distal part of ulna ([Figure 1] panel B, arrow). Purified protein derivative test showed 12 mm induration. HIV, hepatitis B, and hepatitis C serologies were negative. Histopathology from the lesion showed caseating granuloma [Figure 2], and the mycobacterial cultures (BACTEC Mycobacteria Growth Indicator Tube 960) showed growth of mycobacterium TB. She was started on antitubercular therapy, and at the end of 6 months, she was asymptomatic and had radiological improvement.
Figure 1: X-ray left wrist showing a lytic lesion in the distal part of ulna (Panel A, arrow). Magnetic resonance imaging of the left wrist showing focal lytic lesion in the distal part of ulna (Panel B, arrow).

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Figure 2: Histopathology from the lesion showing caseating granuloma (a: H and E, ×10); with histiocytes and epithelioid cells (b: H and E, ×40), langhans giant cell and multinucleated giant cells (c and d: H and E, ×40).

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  Discussion Top


Causes of lytic bone lesions include benign, malignant, and infectious processes.[1] Nonossifying fibroma, solitary bone cysts, aneurysmal bone cysts, giant cell tumors, enchondromas, and osteosarcomas can cause lytic bone lesions. Extrapulmonary manifestations are estimated to occur in approximately 20% of patients with TB.[2] Musculoskeletal TB accounts for 1%–3% of tuberculous infections. The most common form of musculoskeletal TB is tuberculous spondylitis (50%). Extraspinal manifestations are the least common;[3] the reported frequency of peripheral arthritis is 60%, of osteomyelitis 38%, and of tenosynovitis and bursitis 2%. Multifocal involvement is more common than unifocal lesions. Atypical sites and unusual manifestations are seen specifically in the pediatric age group. TB of the hand and wrist is the rarest osteoarticular localization representing 2%–4% of all the cases involving the musculoskeletal system.[4] The nonspecific radiological appearances often delay diagnosis.[5] Radiological features include bone marrow edema, osteoporosis, or lytic lesions.[6] Lytic lesions due to TB may closely mimic those due to tumors such as bone cyst, osteoblastoma, osteosarcoma, and metastatic bone disease radiologically. Histopathology and culture help in definitive diagnosis and prompt management. We describe an immunocompetent patient with isolated lytic bone lesion in the distal part of ulna due to TB to make the readers aware of such unusual presentations of TB.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lemme SD, Kevin Raymond A, Cannon CP, Normand AN, Smith KC, Hughes DP. Primary tuberculosis of bone mimicking a lytic bone tumor. J Pediatr Hematol Oncol 2007;29:198-202.  Back to cited text no. 1
    
2.
Westall J. Tuberculosis levelling off worldwide. BMJ 1997;314:921.  Back to cited text no. 2
    
3.
Hugosson C, Nyman RS, Brismar J, Larsson SG, Lindahl S, Lundstedt C. Imaging of tuberculosis. V. Peripheral osteoarticular and soft-tissue tuberculosis. Acta Radiol 1996;37:512-6.  Back to cited text no. 3
    
4.
Sbai MA, Benzarti S, Bouzaidi K, Sbei F, Maalla R. A rare localization of tuberculosis of the wrist: The scapholunate joint. Int J Mycobacteriol 2015;4:161-4.  Back to cited text no. 4
  [Full text]  
5.
Marzouki A, Bennani A, Almoubaker S, Lahrach K, Boutayeb F. Unusual presentation of isolated metacarpal tuberculosis. Int J Mycobacteriol 2012;1:215-7.  Back to cited text no. 5
  [Full text]  
6.
Aghoutane EM, Salama T, El Fezazi R. Tuberculosis of the wrist in children: A rare manifestation. Int J Mycobacteriol 2017;6:106-7.  Back to cited text no. 6
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