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Abstract
Background
Tuberculosis (TB) is a common disease in a tropical country like India. The commonest mode of presentation is pulmonary, followed by lymphatic, genitourinary, and osteoarticular. An even less common presentation is non-osteoarticular TB in a limb, and this may be bizarre when it involves a bursa or muscle tendon sheath. In such situations there is often a diagnostic problem. We present a consecutive case series of non-osteoarticular TB in the limbs. We look at the various clinical and laboratory aspects that would help to diagnose this uncommon but important presentation.
Materials and methods
All cases of chronic swelling in a limb with possible features of TB, presenting to a busy orthopaedic service, were assessed for history of contact with TB patients, clinical manifestations, radiological findings, Mantoux test, blood erythrocyte sedimentation rate (ESR), fine-needle aspiration cytology (FNAC), core biopsy of swelling, and bacteriological and histopathological examination (HPE) of biopsy material. After confirmation, patients were treated by anti-tuberculous drugs (ATDs) under directly observed treatment, short-course.
Results
Twenty-one suspected cases of non-osteoarticular TB of limb were studied in 3 years. There was an average delay of 8 months in diagnosis after onset of symptoms. Adults of all ages were affected (range 16–62 years) with a male:female ratio of 1:1.6. Diagnosis was confirmed by mycobacterial culture in 5 cases, HPE in 10 cases, and FNAC in 6 cases. All patients responded to ATD. The mean follow-up period was 15 months.
Conclusion
Non-osteoarticular TB in a limb is a diagnostic dilemma and is often not considered in differential diagnosis of any soft tissue swelling in limb. This leads to delay in diagnosis, with further increase in morbidity. Failure to isolate the mycobacterium in culture and sometimes negative histopathological findings make the task more difficult. However, a strong clinical suspicion aided by investigations like FNAC, core biopsy, culture, blood ESR, and Mantoux test can lead to early diagnosis.