Tuberculosis Osteomyelitis as an Indolent Bone Mass

Tuberculosis (TB) is a pulmonary disease with potential extrapulmonary manifestations that is caused by the bacteria Mycobacterium tuberculosis. Despite advancements in treatment, TB remains a worldwide public health concern. TB osteomyelitis accounts for approximately 3-5% of all extrapulmonary TB cases. We present a case of humeral TB osteomyelitis in a 22-month-old female with no pulmonary or systemic symptoms. This case offers insight into the diagnosis and management of TB osteomyelitis. A 22-month-old previously healthy Haitian-American female presented with a one-month history of a palpable mass over the anterolateral aspect of the proximal humerus without overlying erythema or soft tissue swelling. No additional symptoms were reported. She had no recent sick contacts but had visited Haiti during her infancy. Right proximal humerus X-ray and subsequent MRI revealed proximal humeral osteomyelitis with an intraosseous Brodie's abscess. Incision and drainage extracted caseous material, which tested positive for Mycobacterium tuberculosis via a polymerase chain reaction. The diagnosis was confirmed via positive QuantiFERON-TB Gold and purified protein derivative testing. The patient was treated with levofloxacin, isoniazid, pyrazinamide, pyridoxine, and rifampin during the hospitalization. Following discharge, she was continued on her antibiotic regimen and managed by the Florida Department of Health. Post-discharge, X-rays at three and twelve months showed evidence of lesion healing. TB osteomyelitis is a rare manifestation of TB infection, which may present insidiously without systemic or pulmonary symptoms. As timely treatment is vital to preventing complications, bone masses of unknown etiology should be investigated for TB infection, even without additional symptoms.