Tuberculous osteomyelitis in young children.

Twenty-three cases of tuberculous osteomyelitis in children were reviewed. Age at diagnosis ranged from 10 months to 11 years; 17 patients were younger than 3 years. At clinical presentation, patients were generally afebrile with local swelling and painful limb disability. Delay in diagnosis was common, with an average of 4.3 months. Laboratory data showed mild increase in white cell counts and erythrocyte sedimentation rates. However, C-reactive protein levels were all within normal limits except one. Roentgenograms demonstrated osteolytic lesions over metaphyseal areas with surrounding soft-tissue swelling. All patients had received BCG vaccinations at infancy. None of the patients had pulmonary tuberculosis. No familial or environmental history could be attributed to these victims, nor was any immunodeficient disease noted. Bacille Calmette-Guérin (BCG) vaccination was suspected to be the cause of tuberculosis in these young children. All patients received surgical debridement and oral antituberculosis chemotherapy for 1 year. After an average follow-up period of 71.4 months, all children had complete bony healing and excellent clinical results.