Infantile Tuberculous Osteomyelitis of the Proximal Tibia

Background: The manifestations of tuberculosis osteomyelitis in children non-specific. The only early symptoms are pain and swelling of the involved site. Therefore, the disease is often neglected. Case Report: A 17-month-old boy presented with a four-month history of a painful mass over his left lower leg. X-ray of the left knee showed moderate soft tissue swelling over the medial aspect of the left knee. On physical examination, knee mass was fluctuant, minimally tender and non-pulsatile on palpation and without an associated knee effusion. Histological examination of excised specimen confirmed tuberculous granulomas. Post-operatively the child recovered well and was discharged anti-tubercular drugs for 9 months. Conclusion: Early diagnosis of TB osteomyelitis in children poses a challenge. A high index of suspicion for tuberculosis is needed, and it should be included on the list of differential diagnosis in children with musculoskeletal complaints of swelling and stiffness. The absence of pulmonary TB does not exclude the diagnosis of infantile tuberculous osteomyelitis.