Abstract

Osteoarticular tuberculosis accounts for around 1%-3% of all the extrapulmonary tuberculosis, with less than 1% of the infection affecting clavicle. We report a rare case of Primary Tubercular osteomyelitis in a 2 year old child with initially missed diagnosis. A 2 year old male was brought with complaints of exposed medial end of clavicle exposed with discharging bony spicules. There was no history of antecedent trauma, chest infection, cough, sore throat, loss of weight or appetite. Acromioclavicular and sternoclavicular joints were normal. X ray showed a lytic lesion with increased periosteal reaction. Sequestrectomy and curettage was performed. Biopsy report showed areas of central caseous necrosis with multiple epitheloid cell granulomas and giant cells suggestive of tuberculosis. Daily Anti-tubercular multidrug regime with HRZE for 3 months followed by HRE for 9 months was administered. 2 years follow-up showed complete healing of the sinus clinically and radiologically. A suspicion of tubercular osteomyelitis should always be kept in mind while dealing with chronic infective pathologies without constitutional symptoms, presenting with a swelling or a discharging sinus. MRI and biopsy followed by histopathological examination should be the approach, thus, avoiding the spread of the disease to the neighboring joint.

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