Multifocal osteoarticular tuberculosis: report of four cases and review of management

We report the clinical, microbiological, and radiological features of four cases of multifocal osteoarticular tuberculosis, and we review the management of this condition. In each case the initial clinical diagnosis was one of malignant disease, and the possibility of tuberculous bone infection was overlooked. There was neither clinical nor radiological evidence of pulmonary involvement in any case. Antituberculous chemotherapy was initiated in two instances on the basis of histopathologic findings compatible with tuberculous osteomyelitis; such treatment was delayed in the other two cases until the diagnosis was confirmed by culture. Antituberculous chemotherapy alone was successful in three cases, while the fourth case required emergency anterior spinal decompression as well. Two patients developed additional skeletal lesions after the initiation of appropriate antituberculous chemotherapy. Multifocal osteoarticular tuberculosis must be considered in the differential diagnosis of multiple destructive skeletal lesions in all patients from areas where tuberculosis is endemic. This condition may mimic malignant disease both clinically and radiologically.