Tuberculous osteomyelitis of the distal tibia: a rare case report from Syria

Tuberculous osteomyelitis is a rare type of bone infection caused by Mycobacterium tuberculosis hominis. It accounts for approximately 1-3 % of all TB cases and up to 35 % of extra pulmonary cases, with the distal tibia being an uncommon site of infection.

A 28-year-old male, who suffered a blast injury 4 years prior, presented with a worsening pain in the left distal leg and ankle, accompanied by purulent abscess formation and pus discharge. After a trivial fall, X- ray imaging showed a lytic lesion in the distal tibia with a pathological fracture. Surgical intervention involved debridement and curettage of the lesion with external fixation. An excisional biopsy obtained for pathological analysis later confirmed tuberculous osteomyelitis. Following diagnosis, the management included a quadruple anti-tuberculosis regimen, and the patient demonstrated a significant improvement during a short period of time.

Extra-pulmonary tuberculosis mainly affects patients with impaired immune function. However, approximately 1-3 % of immunocompetent individuals can also develop musculoskeletal TB, posing a significant diagnostic challenge. Radiological evaluation includes plain X-rays, computed tomography and MRI. While biochemical tests support the diagnosis, PCR assay and histopathology remain the gold standards. Regarding the management, 6- to-9 months regimens including rifampin are effective, while surgery is typically reserved for cases requiring biopsy and to manage complications in order to expedite healing.

Tibial tuberculous osteomyelitis is a rare diagnosis that requires a high index of suspicion in adults presenting with unexplained bone pain and swelling, especially those who underwent several previous orthopaedic surgeries.