Osteoarticular Tuberculosis Mimicking Ewing’s Sarcoma in an Infant

Yildiz Ekemen Keles; Gulnihan Ustundag; Aslihan Sahin; Dilek Yilmaz; Eda Karadag Oncel; Ahu Kara Aksay; Ahmet Kaya; Gulen Gul; Can Bicmen

doi:10.61107/pacr.2022.014

Yildiz Ekemen Keles¹, Gulnihan Ustundag¹, Aslihan Sahin¹, Dilek Yilmaz², Eda Karadag Oncel¹, Ahu Kara Aksay¹, Ahmet Kaya³, Gulen Gul⁴, Can Bicmen⁵

¹Health Sciences University Tepecik Training And Research Hospital, Department Of Pediatric Infectious Disease, İzmir, Türkiye
²Katip Celebi University, Department Of Pediatric Infectious Disease, Izmir, Türkiye
³Health Sciences University Tepecik Training And Research Hospital, Department Of Orthopedics And Traumatology, İzmir, Türkiye
⁴Health Sciences University Tepecik Training And Research Hospital, Department Of Pathology, İzmir, Türkiye
⁵Dr. Suat Seren Training And Research Hospital For Chest Diseases And Chest Surgery, Microbiology And Clinical Microbiology Laboratory, İzmir, Türkiye

Keywords: Bone tumor, mycobacterium tuberculosis complex, pcr, paraffin-embedded

Abstract

Osteoarticular tuberculosis (TB) of the bone is a rare form of TB, accounting for 1-5% of all extra-pulmonary TB cases worldwide. An otherwise healthy 11-month-old girl complained of swelling on her right wrist and avoidance of using it. She had no history of trauma, fever, weight loss, or other systemic symptoms. A mass on the dorsolateral side of the right wrist, measuring about 4x5cm, was found. In magnetic resonance imaging results, it was reported that there was a mass lesion of lytic character (Ewing’s sarcoma) with periost reaction. Excisional biopsy was performed; non-necrotizing granuloma was found. Mycobacteriological culture could not be performed since the tissue specimen was formalin-fixed and paraffin-embedded. The biopsy material obtained from the bone has no fresh tissue; the M. TB complex was determined upon mycobacteriological molecular examination of the tissue specimen on the waxed block. Therapy lasted for nine months. TB of the bone should be among the differential diagnoses even in the absence of pulmonary involvement and constitutional symptoms of TB. For diagnosis, it is essential to culture for the mycobacterial subtype by tissue biopsy and confirms the culture material by PCR.

Conflict of Interest

The authors declared no conflicts of interest with respect to authorship and/or publication of the article.

Financial Disclosure

The authors received no financial support for the research and/or publication of this article.