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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.
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:
- eccentric lytic lesion with minimal or no periosteal reaction
- a cortical defect may be present
- local osteopaenia
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.
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- 4. Chong S, Herron M, Dolan L et al. TB Osteomyelitis. QJM. 2016;109(11):751-2. doi:10.1093/qjmed/hcw166 - Pubmed
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