Acute suppurative presentation of osteoarticular tuberculosis in children

Osteoarticular tuberculosis is known for its atypical presentations. The acute presentation of osteoarticular tuberculosis although mentioned by many observers is seldom seen in practice. We report the varied presentations of acute suppurative presentation of osteoarticular tuberculosis in pediatric age group.

Our study retrospectively assessed 10 children with osteoarticular tuberculosis who had acute presentation with short history of a few days and signs of acute inflammation.

The age range varied from 3-12 years. The duration of symptoms averaged 14.7 days (range, 4-28 days). Three patients were afebrile at the time of presentation. The diagnosis of tubercular aetiology was made only retrospectively in all the cases. All, except one, were subjected to Fine Needle Aspiration Cytology (FNAC)/ trochar bone biopsy. Diagnosis was based on smear positive for acid fast bacilli (n = 3), histopathology (n = 5), and on clinicoradiological findings in two cases. The acute exudative pattern was seen in seven and gravity assisted tracking and accumulation of abscess (dependent) in three patients. In eight patients, the FNAC/ trochar biopsy decompressed the lesion initially. Incision and drainage were performed on one case of osteoarticular tuberculosis with clinical presentation of acute pyogenic infection. Another patient of acute exudative pattern was subjected to drainage and debridement in view of impending burst. Both exudative and dependent forms of suppurative presentations of osteoarticular tuberculosis responded well to standard antitubercular chemotherapy. The abscesses resolved within a period of 6-12 weeks.

The acute suppurative presentation is a rare and atypical form of osteoarticular tuberculosis. It has close resemblance to acute pyogenic infections or septic arthritis and pose significant diagnostic dilemma for the unwary. A vigilant and methodical approach is the key for managing acute suppurative tubercular presentations.