skeletal tuberculosis

Tuberculous osteomyelitis is one of the rarer musculoskeletal manifestations of tuberculosis.


Tuberculous osteomyelitis accounts for ~20% of musculoskeletal tuberculosis .

Clinical presentation

Patients may present with a painful "cold abscess" with a localized mass/swelling +/- draining sinus with erythema or warmth; a low-grade fever may be present .

There is often a delay between presentation and diagnosis, with a median time to diagnosis reported as 26.4 months .


Most cases are caused by Mycobacterium tuberculosis with non-tuberculosis mycobacterial infections very rare although increased in the settings of AIDS .


Isolated tuberculosis osteomyelitis without associated tuberculous arthropathy most commonly occurs in the metaphyses of the

Radiographic features

Plain radiograph

Plain radiographs can be normal in early infection and when abnormal can show :


Tuberculous osteomyelitis has a variable appearance with signal characteristics similar to pyogenic osteomyelitis (i.e. low T1, high T2) being reported. One study of 11 cases has shown that some cases may have a slightly higher T1 peripheral rim and low-to-intermediate T2 signal and association with soft tissue abscess .

Differential diagnosis

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