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CASE REPORT Table of Contents   
Year : 2003  |  Volume : 37  |  Issue : 3  |  Page : 18
Unusual presentation of tubercular osteomyelitis of femur- A case report


Department of Orthopaedics, IPGMER, Kolkata, India

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How to cite this article:
Chatterjee N D, Hira M, Ghosh T, Goswami A. Unusual presentation of tubercular osteomyelitis of femur- A case report. Indian J Orthop 2003;37:18

How to cite this URL:
Chatterjee N D, Hira M, Ghosh T, Goswami A. Unusual presentation of tubercular osteomyelitis of femur- A case report. Indian J Orthop [serial online] 2003 [cited 2019 Dec 6];37:18. Available from: http://www.ijoonline.com/text.asp?2003/37/3/18/48560

   Introduction Top


In India, tubercular osteomyelitis of long bones is a common entity, presenting with pain and swelling of the local part, with or without discharging sinuses and associated with general symptoms of tuberculosis. Ocassionally tubercular osteomyelitis resembles a neoplasm. We report one such case where tubercular osteomyelitis resembled an extra articular soft tissue tumour.


   Case Report Top


A B, 37 years old Hindu female of high socio-economic status, was admitted with a history of dull aching pain of her left thigh for two months, Associated with intermittent fever, lasting for two hours a day. Maximum rise of temperature was 101 o F. There was loss of appetite and she lost about 10 kg weight in two months. She gave history of childbirth 10 months back and also had history of piles.

On examination, a diffuse swelling was present over the whole of left thigh. Local temperature was normal. Tenderness and slight irregularity was present over the middle of her left femur. Radiograph showed little periosteal reaction of middle of left femur. Clinically and radiologically, this case was diagnosed as chronic osteomyelitis of femur. CT scan revealed collection of pus in the muscle plain of vastus intermedius [Figure 1]. Haematological and Biochemical reports were as follows: Hb - 9gm. %, ESR - 130mm. /hour, T.C.-10,700

Mm 3 Poly - 58%, Lympho - 36%, Eosino - 4% and Monocytes -2%. (Biochemical tests were within normal limits). X-ray chest revealed no abnormality (20.08.2000). ECG was normal. Preoperatively two units of blood were transfused to correct anaemia.

Operatively a huge mass was found on retracting the vastus lateralis. The mass was adherent to the periosteum. Whole mass was split vertically and removed by blunt dissection. No pus or caseous material was found. Swab for culture and sensitivity test revealed no growth. The section of the mass showed striated muscle and adjacent fibrofatty tissue with tubercular granuloma [Figure 2].


   Discussion Top


Osteoarticular tuberculosis comprises of either osseous or extra-osseous variety. Very rarely osteoarticular tuberculosis mimics malignancy. Tuli encountered one case of involvement of radius resembling a neoplasm and 12 cases resembling low-grade pyogenic osteomyelitis out of 33 cases of osteomyelitis of long bones. [1] Clinically and radiological our case resembled a low grade pyogenic osteomyelitis of femur. Peroperatively, we suspected the mass might be either rhabdomyosarcoma or periosteal fibrosarcoma. CT scan did not differentiate between pus and the soft tissue mass. But histological report was suggestive of tubercular granulation tissue. The patient's condition improved with excision of the mass and anti­tubercular drugs within six mo nths.[Figure 3]

 
   References Top

1.Tuli SM. Tuberculosis of the skeletal system. New Delhi; Jaypee Bros.Medical Publishers.1993: 126,127.  Back to cited text no. 1    

Top
Correspondence Address:
A Goswami
Department of Orthopaedics Burdwan Medical College, Burdwan, W.B.
India
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Source of Support: None, Conflict of Interest: None


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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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    Introduction
    Case Report
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    References
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