Multifocal tuberculous osteomyelitis in a 3-year-old child

Area of Science:

• Pediatrics
• Infectious Diseases
• Orthopedics

Background:

• Multifocal skeletal tuberculosis is an uncommon manifestation of tuberculosis, particularly in children, accounting for less than 1% of all tuberculous lesions.
• Diagnosis can be challenging due to its rarity and potential mimicry of other pediatric bone diseases.

Observation:

• A 3-year-old unvaccinated child presented with painless, symmetrical arm swelling, pallor, and enlarged liver and spleen.
• Skeletal imaging revealed lytic lesions in the humeri, rib, and sacrum.

Findings:

• Differential diagnoses considered included Langerhans cell histiocytosis and fibrous dysplasia.
• Acid-fast bacilli were identified in biopsy samples, and real-time polymerase chain reaction confirmed Mycobacterium tuberculosis infection.
• Standard culture for Mycobacterium tuberculosis was negative.

Implications:

• This case highlights the importance of considering multifocal skeletal tuberculosis in the differential diagnosis of pediatric bone lesions.
• Molecular diagnostic techniques like PCR are vital for rapid and accurate identification of Mycobacterium tuberculosis, even when cultures are negative.
• Successful treatment with anti-tuberculous therapy underscores the efficacy of standard treatment regimens for this rare condition.