Clavicular osteomyelitis: a rare presentation of extra pulmonary tuberculosis
A 35-year-old male presented to us with ulcerative lesion over the right shoulder region for 2 years. The lesion was gradually progressive, which later developed a foul-smelling discharge. For this complain, he visited various physicians and was prescribed various antibiotics but there was no relief of complain. There was no history of trauma, cough, pain chest, dyspnoea or fever. Past history was insignificant. There was no history of TB and no one in the family had a history of TB.\nClinical examination revealed an ulcerative lesion 3 × 2.5 × 2.5 cm in the right clavicle at the junction of medial two-third and lateral one-third of the clavicle, with irregular margins, firm base and foul-smelling discharge. Bone was seen exposed with sequestrum present (Fig. ). There was no evidence of cervical or axillary lymphadenopathy and the lung fields were essentially clear. Routine investigations showed moderate hypochromic microcytic anaemia, haemoglobin 9 g/dl, total leukocyte count of 7900 with polymorphs 42%, lymphocytes 54% and eosinophil 4%. Renal and hepatic panels were within normal limit. ESR was 35 mm. The gram staining of the discharge from the ulcer revealed gram-positive cocci, and the Ziehl Nielsen staining for acid-fast bacilli was negative. Culture of the discharge revealed growth of Staphylococcus aureus. ELISA IgG/IgM for TB was negative. HIV-I and II were negative. Chest X-ray was grossly normal (Fig. ). Sequestrectomy was done and the bone along with the excised tissue was sent for biopsy. Histopathology showed it to be either foreign body granuloma or rare possibility of tubercular pathology.\nPatient put on Category I ATT. Patient responded to treatment. The ulcer over shoulder healed in 6 weeks (Fig. ) with formation of granulation tissue. Patient completed full course of ATT and is doing well on regular follow-ups.