Proximal tibial tuberculous osteomyelitis with secondary knee joint arthritis: A case report

Tuberculous osteomyelitis is an uncommon form of musculoskeletal tuberculosis and most frequently involves long bones such as the femur and tibia. We report the case of a 53-year-old woman presenting with a one-year history of progressive pain and swelling of the left knee. Imaging revealed a well-defined lytic cavitary lesion in the metaphyseal-epiphyseal region of the proximal tibia with cortical breach, intra-articular extension, and direct communication with a pre-tibial soft-tissue abscess. Surgical management included debridement and curettage of the intramedullary cavity, drainage of the pre-tibial collection, PMMA cement filling, and a knee joint washout. Histopathological analysis demonstrated epithelioid granulomas with Langhans-type giant cells and caseous necrosis, and PCR confirmed <i>Mycobacterium tuberculosis</i>. This case highlights the importance of considering tuberculous osteomyelitis in the differential diagnosis of chronic osteolytic lesions with associated soft-tissue collections or secondary joint involvement, particularly in endemic regions.