Pediatric Atypical Ulnar Tubercular Osteomyelitis with Diagnostic Dilemma

ABSTRACT: Skeletal tuberculosis (TB) remains a significant clinical entity, particularly in developing nations, where extrapulmonary TB contributes substantially to morbidity. TB involving the upper limb bones is rare, particularly in the pediatric population. We report a case of isolated ulnar bone TB in an 11-year-old girl who was initially misdiagnosed as having a traumatic ulnar fracture following minor trauma. Diagnosis was confirmed through microbiological examination using Ziehl-Neelsen staining, cartridge-based nucleic acid amplification test, and culture. After pus aspiration, sinus excision, and daily wound care, antitubercular therapy was initiated based on the patient's body weight according to the pediatric TB guidelines. Following immobilization in cast and structured rehabilitation, the patient achieved radiological and functional recovery over 15 months. This case highlights the diagnostic challenges of atypical skeletal TB and emphasizes the significance of early suspicion, microbiological confirmation, and tailored conservative management for achieving excellent outcomes.