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).