Tuberculous osteomyelitis

Last revised by Jeremy Jones on 6 Oct 2021

Tuberculous osteomyelitis is one of the rarer musculoskeletal manifestations of tuberculosis.

Tuberculous osteomyelitis accounts for ~20% of musculoskeletal tuberculosis 5.

Patients may present with a painful "cold abscess" with a localized mass/swelling +/- draining sinus with erythema or warmth; a low-grade fever may be present 2,4

There is often a delay between presentation and diagnosis, with a median time to diagnosis reported as 26.4 months 4

Most cases are caused by Mycobacterium tuberculosis with non-tuberculosis mycobacterial infections very rare although increased in the settings of AIDS 3

Isolated tuberculosis osteomyelitis without associated tuberculous arthropathy most commonly occurs in the metaphyses of the 1

Plain radiographs can be normal in early infection and when abnormal can show 2,5:

Tuberculous osteomyelitis has a variable appearance with signal characteristics similar to pyogenic osteomyelitis (i.e. low T1, high T2) being reported. One study of 11 cases has shown that some cases may have a slightly higher T1 peripheral rim and low-to-intermediate T2 signal and association with soft tissue abscess 5.

ADVERTISEMENT: Supporters see fewer/no ads