Case of tuberculosis acromioclavicular joint presenting as lytic lesion in lateral end clavicle: rare case report

Abstract

Background: Rise in the incidence of tuberculosis (TB) seen in recent years. Skeletal TB accounts for less than 10% of all cases of TB. Most of these cases are in the spine and hip. The acromio-clavicular (AC) joint is a very uncommon site of skeletal TB. Case report: A 30 year old female developed pain in her right shoulder after sustaining trivial trauma. She was treated conservatively for six weeks, but patient complaints of increase in the intensity of pain with restricted movements. Radiographs repeated after six weeks showed a lytic lesion in the lateral end of clavicle with differential diagnosis of a solitary bone cyst or metastatic lesion. FNAC of the swelling done and MRI right shoulder advised. Histo-pathological report revealed evidence consistent with TB. The patient started on a multidrug anti-tubercular therapy (ATT) regimen with diagnosis of tuberculosis lateral end clavicle. MRI report after two weeks showed synovial hypertrophy and capsular distension with mild joint effusion in right AC joint. The diagnosis changed to tuberculosis of AC joint with continuation of the same treatment. Conclusion: The rarity of the occurrence of TB at unusual sites, and the ability of tuberculosis to mimic other diseases, combined with a lack of awareness by the treating orthopaedist often leads to diagnostic delays. A high index of suspicion should be maintained in cases of swellings around the shoulder, even if they lack systemic features of tuberculosis.rn