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Extrapulmonary Tuberculosis Mimicking an Iliac Bone Lytic Lesion: A Case Report
Mohammed Mushabbab Alobud1, Sami Amer M Alqarni1, Bandar Saeed Alqahtani1
1Orthopaedic Surgery, Armed Forces Hospital Southern Region, Khamis Mushait, SAU.
Cureus
|July 3, 2025
Summary
Tuberculous osteomyelitis can mimic malignancy in lytic bone lesions. Diagnosis may rely on histopathology and treatment response, even with negative cultures, especially in endemic populations.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Radiology
Background:
- Lytic bone lesions present diagnostic challenges, with varied etiologies including malignancy, infection, and benign conditions.
- Tuberculous osteomyelitis is a rare but critical consideration, particularly in individuals from tuberculosis (TB) endemic regions.
Observation:
- A 35-year-old male from a TB-endemic area presented with chronic iliac pain and an expansile lytic bone lesion suggestive of malignancy.
- Biopsy revealed necrotizing granulomatous osteomyelitis, but cultures for Mycobacterium tuberculosis were negative.
Findings:
- The patient demonstrated clinical and radiological improvement with empirical anti-tuberculosis therapy, despite negative microbiological confirmation.
- Histopathological evidence of granulomas and therapeutic response supported the diagnosis of tuberculous osteomyelitis.
Implications:
- Tuberculous osteomyelitis should be considered in the differential diagnosis of lytic bone lesions, even with negative cultures, in endemic populations.
- Histopathology and response to anti-TB therapy are crucial for diagnosis when microbiological tests are inconclusive, preventing treatment delays.
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