Osteoarticular tuberculosis in infancy and its clinical outcome: A case series
Devarani Pancharatnam1
, Yang Zhen Soo1, Xin Xin Faith Hii2, Yee Wei Voon3, Muhammad Lutfi Abdul Rashid1, Saw Aik1, Azura Mansor1, Kwong Weng Loh1
1
National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
2Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
3Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
Keywords: Bacille Calmette-Guérin osteomyelitis, infancy, Mycobacterium tuberculosis, osteoarticular, polymerase chain reaction.
Abstract
Osteoarticular tuberculosis (TB) in infancy is rare, often presenting with non-specific clinical features that delay diagnosis and treatment. In this article, we present a case series of seven infants diagnosed with osteoarticular TB at a tertiary center. The patients (6 girls, 1 boy; aged 9 to 12 months) presented with painless, progressive limb swelling involving the femur, tibia, and ankle. Only one had intermittent low-grade fever. Mycobacterium tuberculosis complex was detected by polymerase chain reaction (PCR) in six cases, and three cases were culture-positive for Mycobacterium bovis (Bacille CalmetteGuérin [BCG] strain). All compliant patients received standard anti-tuberculosis therapy (2HRZE/10HR) and were followed for at least three years. One child developed pyrazinamide-induced hepatotoxicity, which was managed successfully with monitored reintroduction of therapy. Five patients showed complete radiological and functional recovery with normal gait and no limb-length discrepancy at a minimum three-year follow-up. Two patients were lost to follow-up. In conclusion, early suspicion, combined with histopathological evaluation and nucleic acid amplification testing, is crucial for prompt diagnosis. Despite its rarity, osteoarticular TB should be considered in infants with unexplained limb swelling, even in the absence of systemic features. Timely surgical intervention and adherence to therapy result in excellent clinical outcomes.
Citation: Pancharatnam D, Soo YZ, Hii XXF, Voon YW, Rashid MLA, Aik S, et al. Osteoarticular tuberculosis in infancy and its clinical outcome: A case series. Jt Dis Relat Surg 2027;38(x):1-11. doi: 10.52312/jdrs.2027.2828.