Osseous manifestations of tuberculosis in children.

Forty-two children with tuberculous osteomyelitis were seen and treated between 1984 and 1999. The age ranged from 1 to 12 years (average 6); there were 31 boys and 11 girls. There were 50 osseous lesions (excluding spinal and synovial). Five children had multifocal bone involvement. There were four basic types of lesions: cystic (n = 26), infiltrative (n = 10), focal erosions (n = 8), and spina ventosa (n = 6). The majority of the lesions were in the metaphyses (n = 25); the remainder were in the diaphysis, epiphysis, short tubular bones, flat bones, and small round bones. The erythrocyte sedimentation rate was normal in seven, and the Mantoux test was negative in four. Bone lesions resembled pyogenic and fungal infections and benign and malignant bone tumors. Histologic confirmation was obtained in all patients. Curettage and antituberculous treatment yielded good results in the majority of patients, with follow-up of 6 months to 9 years. Biopsy is mandatory to confirm the diagnosis.