What is multifocal TB?

Multifocal skeletal TB is defined as osteoarticular lesions that occur simultaneously in two or more locations, with or without pulmonary involvement. It is uncommon, with a reported incidence of 7 10%,4 and is usually associated with disseminated disease.

What is tuberculous osteomyelitis?

Tuberculous osteomyelitis occurs secondary to lymphohematogenous spread of Mycobacterium tuberculosis from a pulmonary focus [5]. Clinical symptoms are very nonspecific and can include insidious onset of pain, swelling, decreased range of motion and difficulty ambulating.

Can TB cause osteomyelitis?

Tuberculous osteomyelitis and arthritis accounts for 10% of the cases of extrapulmonary tuberculosis. Tuberculous osteomyelitis, like other forms of extrapulmonary tuberculosis, is secondary to lymphohematogenous dissemination to bones from the lungs. Tuberculosis has been reported to affect all the bones in the body.

Can TB cause bone lesions?

Bone lesions caused by TB can occur in other locations on the skeleton, but occur most frequently at major joints such as the hip and knee. These sites account for 15% to 30% and 10% to 20% of non-spinal cases of skeletal TB, respectively [10], [14].

What is skeletal tuberculosis?

Skeletal tuberculosis (TB) refers to TB involvement of the bones and/or joints. It is an ancient disease; features of spinal TB have been identified in Egyptian mummies dating back 9000 years [1,2], and analysis of 483 pre-Columbian skeletons in Chile showed lesions consistent with bony TB in 2 percent of cases [3].

What is extrapulmonary tuberculosis?

Extrapulmonary tuberculosis (EPTB) is tuberculosis outside of the lungs. EPTB includes tuberculosis meningitis, abdominal tuberculosis (usually with ascites), skeletal tuberculosis, Pott’s disease (spine), scrofula (lymphadenitis), and genitourinary (renal) tuberculosis.

What causes tuberculous osteomyelitis?

Tuberculosis osteomyelitis of the bone is a rare condition caused by the Mycobacterium tuberculosis. Its incidence has increased in Western countries in recent years due to HIV infection, increasing elderly population and emerging resistant strains.

What are extrapulmonary TB symptoms?

Symptoms include fever, chills, weakness, malaise, and often progressive dyspnea. Intermittent dissemination of tubercle bacilli may lead to a prolonged fever of unknown origin (FUO). Bone marrow involvement may cause anemia, thrombocytopenia, or a leukemoid reaction.

How is multifocal tuberculous osteomyelitis (TB) diagnosed?

The differential diagnosis of multifocal tuberculous osteomyelitis includes eosinophilic granulomas, sarcoidosis, multiple myeloma, cystic angiomatosis, lymphoma and even metastases. Skeletal TB is a late complication of lymphohematogenous spread and usually presents many years following primary infection.

Can tubercular osteomyelitis occur in the ribs?

Also, very few cases of skeletal TB involve ribs [5]. Multifocal tubercular osteomyelitis rarely occurs, especially in nonimmunocompromised patients from nonendemic areas of the world with no pulmonary involvement. It must be considered in the differential diagnosis of multiple destructive skeletal lesions.

How common is skeletal tuberculosis (TB)?

Skeletal tuberculosis (TB) accounts for about 1–2% of all TB cases and 10% of extrapulmonary TB cases. We present a 19-year-old male with multifocal tubercular osteomyelitis, who presented with progressively worsening back pain, weight loss, fatigue, anorexia, decreased mobility, low-grade fever, and night sweats—but without pulmonary involvement.

How are tuberculous osteomyelitis and meningitis treated?

Treatment of tuberculous osteomyelitis and meningitis are similar, although the length of treatment differs. For tuberculous osteomyelitis in children, the Centers for Disease Control and Prevention recommends isoniazid, rifampin, and pyrazinamide for 8 weeks, followed by 4 to 7 months of isoniazid and rifampin.