Vijay Kumar Jain1, Karthikeyan P Iyengar2, Nipun Rana3, Anil Agarwal4, Rajesh Botchu5. 1. Professor, Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India. 2. Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK. 3. Consultant, GRIPMER, Sir Ganga Ram Hospital, New Delhi, India. 4. Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India. 5. Consultant Musculoskeletal Radiologist, Royal Orthopedic Hospital, Birmingham, UK.
Abstract
Background: Osteo-articular Mycobacterium tuberculosis infection of the ischial tuberosity is a rare cause of gluteal pain. Methods: A retrospective clinico-radiological review of nine patients with Mycobacterium tuberculosis infection of the ischial tuberosity was undertaken. The spectrum of presenting features, diagnostic challenges, radiological findings with particular emphasis on Magnetic resonance imaging (MRI) and clinical course was reviewed. Results: All the 9 patients (5 male: 4 female) aged between 8 and 50 years of age (mean 15.3 years) developed insidious onset of buttock pain over a period of weeks to months with difficulty in walking. Microbiological and/or histopathological confirmation of Mycobacterium tuberculosis infection was undertaken in all cases. Complementary MRI revealed diffuse bone marrow signal hypointense or isointense on T1-weighted and hyperintense on T2-weighted and STIR images. MRI was able to provide anatomic details of soft tissue lesions and extensions. MRI illustrated the sinus tract in one patient. Ultrasound imaging allowed diagnostic and therapeutic management of in 3 patients. Conclusion: Tuberculosis of ischial tuberosity can be a rare cause of gluteal pain. Delay in diagnosis could be due to an indolent natural history, unusual presentation and clinical features. A high index of suspicion especially in endemic areas with complementary imaging and microbiological or histopathological confirmation of Mycobacterium tuberculosis infection is necessary for definitive diagnosis. Targeted treatment under the umbrella of Anti-Tubercular Therapy is crucial in achieving successful clinical outcome.
Background: Osteo-articular Mycobacterium tuberculosis infection of the ischial tuberosity is a rare cause of gluteal pain. Methods: A retrospective clinico-radiological review of nine patients with Mycobacterium tuberculosis infection of the ischial tuberosity was undertaken. The spectrum of presenting features, diagnostic challenges, radiological findings with particular emphasis on Magnetic resonance imaging (MRI) and clinical course was reviewed. Results: All the 9 patients (5 male: 4 female) aged between 8 and 50 years of age (mean 15.3 years) developed insidious onset of buttock pain over a period of weeks to months with difficulty in walking. Microbiological and/or histopathological confirmation of Mycobacterium tuberculosis infection was undertaken in all cases. Complementary MRI revealed diffuse bone marrow signal hypointense or isointense on T1-weighted and hyperintense on T2-weighted and STIR images. MRI was able to provide anatomic details of soft tissue lesions and extensions. MRI illustrated the sinus tract in one patient. Ultrasound imaging allowed diagnostic and therapeutic management of in 3 patients. Conclusion: Tuberculosis of ischial tuberosity can be a rare cause of gluteal pain. Delay in diagnosis could be due to an indolent natural history, unusual presentation and clinical features. A high index of suspicion especially in endemic areas with complementary imaging and microbiological or histopathological confirmation of Mycobacterium tuberculosis infection is necessary for definitive diagnosis. Targeted treatment under the umbrella of Anti-Tubercular Therapy is crucial in achieving successful clinical outcome.