Multifocal Sceletal Osteomyelitis Tuberculosis in 16-year-old-boy

Background: Tuberculosis (TB), a re-emerging disease in developing countries, could lead to multiple complications via hematogenous spread. Osteomyelitis is a rare complication of TB infection in children. Those symptoms were not specific which could precede with swelling and pain at the involved limbs. Case Presentation Summary : A 16-year-old boy was brought to the ER with chief complaints of swollen and tenderness in both ankle for the last two weeks. He had fever, loss of body weight, pale, and malaise, but no history of chronic cough neither trauma. The ROM of both feet were limited. Ulceration in the right ankle produced serous fluid one week later. His uncle and step sister (lived in the same house), had been treated for pulmonary TB. Laboratory investigations showed leukocytosis, increased ESR and CRP level. Chest X-ray, sputum examination, and tuberculin test were inconclusive of TB. HIV screening was negative. X-ray of left os radius-humerus, and both ankle (os tibia, thalus) revealed multiple osteolytic lesions. X-ray of vertebrae revealed multiple compression fractures in lumbal region. Multiple osteolytic lesions were confirmed as osteomyelitis from MRI. He underwent surgical debridement of suspected affected bones and joints followed by a series of microbiology and pathology examination of bone tissue and synovial fluid. The results were positive M. tuberculosis infection, proven by acid fast stain, real time PCR, and culture with Lowenstein Jensen media. He treated with anti-TB drugs (RHZE regimens). The fever subsided five days after therapy and the clinical condition improved significantly. Learning Points/Discussion : Tuberculosis is still a serious health problem throughout the worlds. Osteomyelitis TB must always be kept in mind in the differential diagnosis of lytic lesions encountered in the long bones of children. Complete healing could be obtained by means of surgical resection and post-operative anti-TB therapy.