ArticleJournal of orthopaedic case reports2026
Primary Tuberculous Osteomyelitis of the Proximal Tibia Presenting as Chronic Osteomyelitis: A Diagnostic Challenge in Musculoskeletal Tuberculosis.
Article in Journal of orthopaedic case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Tuberculous involvement of long bones is an uncommon form of extrapulmonary tuberculosis (TB) and frequently poses a diagnostic dilemma because of its indolent presentation and non-specific imaging features. Tibial tuberculous osteomyelitis is particularly rare and may closely mimic subacute pyogenic osteomyelitis or Brodie's abscess, especially in immunocompetent individuals, leading to delayed diagnosis. Case Report: A 70-year-old immunocompetent male presented with a short duration of pain and swelling over the proximal tibia without constitutional symptoms. Radiographs showed a lytic metaphyseal lesion with cortical thinning, while magnetic resonance imaging revealed an intramedullary abscess cavity with surrounding marrow edema and minimal soft-tissue extension, suggestive of subacute osteomyelitis. Routine bacterial cultures were negative. Intraoperative aspirate tested positive for Mycobacterium TB on cartridge-based nucleic acid amplification test, confirming tuberculous osteomyelitis. The patient underwent intramedullary debridement, abscess drainage, and dead-space management with antibiotic-loaded calcium sulfate beads, followed by initiation of standard multidrug antitubercular therapy. Post-operative radiographs demonstrated adequate lesion clearance and maintained alignment, with progressive clinical improvement on follow-up. Conclusion: Tibial tuberculous osteomyelitis should be considered in the differential diagnosis of metaphyseal lytic lesions resembling Brodie's abscess, even in immunocompetent patients with short-duration symptoms. Early biopsy and molecular diagnostics such as cartridge-based nucleic acid amplification tests are crucial for timely diagnosis. Combined surgical debridement and antitubercular therapy resulted in a favorable outcome in this patient. Further studies are required to determine the reproducibility of this approach.
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