Osteitis tuberculosa multiplex cystoides

Case contributed by Dr Supika Kritsaneepaiboon

Presentation

A 11 year-old boy diagnosed pediatric AIDS presented with wrist swelling and fever for 7 months

Patient Data

Age: 11 years old
Gender: Male
Modality: X-ray

Oblique view of both hand radiograph and lateral view of left elbow show soft tissue swelling and multiple cystic bony destructions involving all long tubular bones and carpal bones. Benign solid periosteal reaction along left humerus is partly visualized.

Case Discussion

The patient was known case of pediatric AIDS and diagnosed disseminated tuberculosis. He re-visited hospital with both wrist and left elbow swelling, multiple skin abscesses at left and, right axilla, and left elbow. The AFB staining from the abscesses were positive1+ at right hand, 3+ at right axilla and 1+ at left elbow. The left epitrochlear nodes are enlarged and positive AFB staining 1+.

The plain radiograph of both hands and left elbow show multiple cystic osteolytic lesions involving all long tubular bones and carpal bones. This case demonstrates "osteitis tuberculosa multiplex cystoides" or "Jungling's disease" which is the multifocal musculoskeletal TB and often found in disseminated disease and conjoined with pulmonary infection.  The differential diagnoses are categorized in infection (e.g. disseminated pyogenic osteomyelitis) and neoplasms (e.g. eosinophilic granuloma or small round cell tumors).

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Case Information

rID: 43501
Case created: 14th Mar 2016
Last edited: 24th Mar 2016
Inclusion in quiz mode: Included

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