Avascular necrosis of humeral head in an elderly patient with tuberculosis: a case reportReport as inadecuate

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Journal of Medical Case Reports

, 2:361

First Online: 04 December 2008Received: 06 February 2008Accepted: 04 December 2008DOI: 10.1186-1752-1947-2-361

Cite this article as: Agarwal, R., Gupta, R., Singh, S. et al. J Med Case Reports 2008 2: 361. doi:10.1186-1752-1947-2-361


IntroductionOsteonecrosis avascular necrosis is known to be caused by high-dose corticosteroid therapy, alcoholism and rarely by infections. However, a tubercular etiology of this condition is very rare. A review of the literature yielded only a few cases of polyarticular tuberculosis with osteonecrosis in immunosuppressed individuals. No case of monoarticular tubercular osteonecrosis diagnosed by aspiration cytology was found. Since tuberculosis is a curable disease, an early and accurate diagnosis is essential.

Case presentationA 60-year-old Indian man presented with diffuse swelling and pain in the left shoulder for the previous 6 months. A computed tomography scan of the left shoulder revealed crescentic lucency in the humeral head, suggestive of osteonecrosis. Fine needle aspiration cytology smears from the swelling showed features of an acute suppurative lesion. Stain for acid-fast bacillus was positive and thus, a final clinico-pathological diagnosis of osteonecrosis of humeral head with tubercular etiology was rendered. The patient was initiated on anti-tuberculous therapy with symptomatic improvement in his condition.

ConclusionOsteonecrosis, a debilitating disease, may rarely occur due to tuberculosis, especially in endemic areas. Fine needle aspiration cytology is an effective and inexpensive modality for an early diagnosis of the tubercular etiology of osteonecrosis.

AbbreviationsANAanti-nuclear antibody

AVNavascular necrosis

CTcomputed tomography

ESRerythrocyte sedimentation rate

FNAfine needle aspiration

HIVHuman Immunodeficiency Virus

MRImagnetic resonance imaging

PPDpurified protein derivative

TUtuberculin units.

Electronic supplementary materialThe online version of this article doi:10.1186-1752-1947-2-361 contains supplementary material, which is available to authorized users.

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Author: Renu Agarwal - Ruchika Gupta - Sompal Singh - Kusum Gupta - Madhur Kudesia

Source: https://link.springer.com/

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