Carpal synovitis with capitate bone tuberculosis in a child

Area of Science:

• Orthopedics
• Infectious Diseases
• Pediatrics

Background:

• Wrist pain and inflammation in children can be caused by various conditions, including infections.
• Septic arthritis is a common suspicion in cases of acute joint inflammation with elevated inflammatory markers.

Observation:

• A 10-year-old boy presented with a 2-month history of non-traumatic wrist pain and inflammatory signs.
• Initial investigations revealed elevated inflammatory markers, increased synovial fluid in radiocarpal and intercarpal joints, and no bony lesions.
• The patient did not respond to conventional treatment for suspected septic arthritis.

Findings:

• Magnetic resonance imaging (MRI) demonstrated synovitis around the carpus and a lytic lesion in the capitate bone, suggestive of osteomyelitis.
• A biopsy identified *Mycobacterium tuberculosis* as the causative agent.
• The patient was treated with antibiotics.

Implications:

• This case highlights that tuberculosis osteomyelitis can present as wrist pain and inflammation in children, mimicking septic arthritis.
• Prompt diagnosis through biopsy and appropriate antibiotic therapy led to significant clinical improvement and bone remodeling.
• It underscores the importance of considering atypical infections in pediatric patients with persistent joint symptoms unresponsive to standard treatments.