Tubercular Osteomyelitis Mimic Ewing's Sarcoma

Ewing's sarcoma in children is an extremely rare malignant tumor that is frequently challenging to identify. In addition to its rarity in young children, Ewing's sarcoma can resemble an infectious disease, contributing to diagnostic delay. Both conditions have similar presenting symptoms, such as general weakness, pain, and fever.

We present a case of a 13-year-old girl with pain over the right distal humerus for 2 months. X-ray findings showed lesions over the distal humerus which led to a differential diagnosis of osteomyelitis and Ewing's sarcoma. The patient underwent bone biopsy and was diagnosed with tuberculous osteomyelitis and was managed conservatively in the form of antituberculosis treatment.

For distinguishing Ewing's sarcoma from osteomyelitis, imaging modalities can be unreliable, and these patients require a higher diagnostic yield in the form of a bone biopsy for greater accuracy.