Scapula Abscess Secondary to Shoulder Tuberculosis: Case Report with Review of Literature

Tuberculosis (TB) of shoulder joint is uncommon. It has an incidence rate of 0.9-1.7%. We report a case of 50 year old man presenting with cold abscess over scapula bone, secondary to the shoulder joint involvement (with sinus tracking to the anterior aspect of shoulder joint).

A 50-year-old male presented to our hospital with complaints of swelling over right scapular area since 2 months. The patient had similar swelling on the anterior aspect of right shoulder about 4 months back, which drained spontaneously forming a sinus. At presentation, this sinus was healed but patient had a new sinus track in axilla draining pus. This patient also had a history of constitutional symptoms. His investigations were indicative of infective arthritis of the shoulder with humeral head destruction with associated abscess extending along the back and rotator cuff muscles. We treated this patient with incision and drainage of the scapular abscess. Around 100 mL of pus was drained. Furthermore, anterior aspect of shoulder was exposed to debride shoulder joint. Mycobacterium TB was isolated on gene expert and the patient was started on anti- TB treatment regimen (ATT; DOTS- category I). On subsequent follow-up, the patient had complete resolution of symptoms within 4 months. His overall condition improved - his appetite increased and he also gained weight.

High degree of suspicion should be kept in mind in diagnosing shoulder TB. Once diagnosed, the prognosis is excellent with appropriate treatment-ATT alone or in combination with surgical debridement.