A 6-year boy reported with multiple
swellings on the dorsum of both hands and elbows and low
grade fever for 6 months. He had received multiple
antibiotics without any response. Examination revealed
cervico-axillary lymphadenopathy with irregular soft
swellings on the dorsum of both hands and elbows. Overlying
skin was erythematous with ulcers having bluish thin
undermined margins and serosanguinous ooze (Fig. 1).
Investigations revealed ESR 50mm, Mantoux 15mm and normal
chest skiagram. X-ray hands revealed multiple lytic
lesions and surrounding sclerosis (honeycombing) in
metacarpals and multiple, oval, cystic lesions with variable
sclerosis in radius and humerus (Fig. 2). FNAC
of lymph nodes and skin biopsy from the dorsum of hands
revealed granulomatous pathology suggestive of tuberculosis.
Patient responded to antitubercular treatment.
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Fig.1 Erythematous skin with
characteristic ulcers.
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Fig. 2 Lytic lesions
in bones.
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Multiple cystic tuberculosis is a rare
form of tubercular osteomyelitis. The cysts may be solitary
or multiple, radiolucent, round to oval, situated in the
peripheral skeleton near the metaphysis. The commonly
affected sites in order of frequency are spine, tibia, ulna,
radius, femur, fibula and humerus. The differential
diagnosis includes bacterial or fungal infection, aneurysmal
bone cysts, cartilaginous tumors and osteoid osteomas.
Biopsy may be required to confirm such cases. ATT is the
mainstay of treatment. Surgery may be required in a few
cases with extensive disease.
