Bone & joints


Tuberculous osteomyelitis

Last author update: 1 August 2013
Last staff update: 25 May 2023

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PubMed Search: Tuberculous osteomyelitis[title]

Dariusz Borys, M.D.
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Cite this page: Borys D. Tuberculous osteomyelitis. website. Accessed April 14th, 2024.
Definition / general
    Osteomyelitis - general
    • Infection of bone (osteitis) or bone marrow space (myelitis) = osteomyelitis
    • Usually pyogenic, fungal or tubercular
    • HIV+ patients may be infected by unusual organisms (eg. Mycobacterium avium)
    • Radiographically may resemble a neoplasm, particularly after antibiotic treatment
    • Severe osteomyelitis is not associated with grade IV sacral decubitus ulcers in non-septic patients; imaging may be misleading (Arch Pathol Lab Med 2003;127:1599)
    • May cause secondary AA amyloidosis

    Osteomyelitis - tuberculous
    • Usually young adults or children

    Pott's disease:
    • Involvement of spine (thoracic / lumbar)
    • Extensive necrosis of intervertebral discs with extension into soft tissue
    • May produce significant deformities or neurologic deficits
    • Difficult to treat
Clinical features
  • In US, due to immigrants and immunosuppression
  • 1 - 3% with tuberculosis have bone infection, usually from focus of acute visceral disease, direct extension or lymphatics
  • Rarely causes inguinal mass with fluctuant psoas abscess
  • In AIDS patients, bone infection usually multifocal
  • Advanced cases are associated with cutaneous sinuses, which cause secondary bacterial infections
  • Associated with fusion of joint, denudation of cartilage, sequestra of medullary cavity
  • Can detect in synovial fluid by culture and examination
  • Vertebrae, hip, knee, ankle, elbow, wrist
  • Usually involves synovium, epiphysis or metaphysis
Radiology images

Contributed by Mark R. Wick, M.D.
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Paraspinal tuberculous abscess MRI

Gross images

Contributed by Mark R. Wick, M.D.
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Tubeculous vertebral osteomyelitis

Microscopic (histologic) images

Contributed by Mark R. Wick, M.D.
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Various images

Differential diagnosis
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