Title : An intriguingly rare case of TB osteomyelitis of humerus presenting as pathological fracture!!
Abstract:
BACKGROUND:
Among extra-pulmonary TB, osteoarticular involvement is seen in 10% patients. Commonly TB affects spine and hip joint, it also affects knee joint, foot bones, hand bones and elbow joint, rarely shoulder joint which accounts for 1-2%. Among shoulder joint TB, Isolated tuberculous osteomyelitis of the proximal humerus without involvement of shoulder joint is unusual and there is not much literature studies.
CASE PRESENTATION:
A 28-year-old male presented with complaints of swelling, pain and inability to raise the left shoulder for 10 days. Patient had generalised malaise, loss of appetite and weight loss for 2 months. Local examination revealed warmth and tenderness over the left shoulder, restriction of movements in all planes. There were no external injuries or discharging sinuses. Routine hemogram revealed Erythrocyte sedimentation rate – 62mm/h, Total count- 9,800/cumm, Neutrophils – 60%, Lymphocytes – 28%. Plain radiograph followed by MRI of the left shoulder revealed a fairly ill-defined lesion measuring 8.5*4.8*5.5 cm seen involving the distal half of the head, neck and proximal shaft of left humerus causing remarkable irregular bony destruction and pathological fracture with multiple bony fracture fragments. Irregular thickened discontinuous cortical thickening and periosteal reaction noted. Gleno-humeral joint, glenoid labrum appeared normal. Associated soft tissue component involving humerus and extends inferomedially below subscapularis for a distance of 9.5 cm with maximum thickness of 2.7 cm and involves teres major. CT Chest showed no lung parenchymal abnormality.
DIAGNOSIS:
J-Needle biopsy was done from the proximal humerus and biopsy revealed epitheloid cell granuloma, occasional langhans giant cells and lymphocytic infiltrate. Pus was aspirated from the cold abcess was sent for Gene Xpert and Mycobacterium Tuberculosis was detected in low levels with Rifampicin sensitivity.
CONCLUSION:
Based on Histopathology and Gene Xpert patient was started on Anti tubercular drugs 4 fixed dose combination, Thorough debridement of the lesion using deltopectoral approach was done. Patient was advised immobilisation in removable polythene brace for 3 months
