Extrapulmonary tuberculosis: importance of differential diagnosis

Area of Science:

• Infectious Diseases
• Osteoarticular Infections
• Microbiology

Background:

• Extrapulmonary tuberculosis, particularly osteoarticular TB, presents a significant clinical challenge with high morbidity.
• Diagnosis relies on culture and histopathology, but can be complicated by atypical presentations.
• Tuberculosis (TB) is a major global health concern, necessitating accurate diagnostic approaches.

Observation:

• A 53-year-old female farmer presented with clinical and imaging findings suggestive of tuberculous osteomyelitis.
• The patient had no known TB contacts, and diagnostic tests for TB (tuberculin skin test, interferon-γ release assay) were negative.
• Tissue biopsy cultures unexpectedly isolated Brucella melitensis.

Findings:

• Brucella melitensis was identified as the causative agent of the osteoarticular infection.
• Treatment for brucellosis resulted in a favorable clinical outcome for the patient.
• The case underscores the diagnostic challenges in differentiating osteoarticular infections.

Implications:

• Accurate diagnosis considering epidemiological context is crucial for effective treatment of osteoarticular infections.
• Brucellosis should be considered in the differential diagnosis of osteomyelitis, especially in endemic areas or in individuals with relevant exposures.
• This case highlights the importance of comprehensive microbiological investigations in complex infectious disease presentations.