Multifocal musculoskeletal cystic tuberculosis without systemic manifestations

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Radiology

Background:

• Tuberculosis (TB) typically presents with pulmonary involvement, but extrapulmonary TB can affect various sites.
• Multifocal involvement indicates TB spread to multiple distinct locations in the body.
• Cystic presentations of TB are less common than caseating granulomas.

Observation:

• A 34-year-old male immigrant from Yemen presented with multifocal cystic lesions.
• The clavicle and iliac bones were significantly affected, with substantial soft tissue extension.
• The patient exhibited no systemic signs of infection despite the widespread disease.

Findings:

• The extensive cystic nature of the bone and soft tissue lesions was a key characteristic.
• The absence of fever, weight loss, or elevated inflammatory markers was notable.
• Imaging studies revealed well-defined cystic masses within the affected bones.

Implications:

• This case highlights the diverse and sometimes atypical manifestations of extrapulmonary tuberculosis.
• It underscores the importance of considering TB in the differential diagnosis of cystic bone lesions, especially in endemic populations.
• Further research into the pathogenesis of cystic TB may be warranted.