Case Report

Tuberculous Osteomyelitis Presenting as Shoulder Pain

PAUL A. MONACH, JOHANNA P. DAILY, GAMALIEL RODRIGUEZ-HERRERA, and DANIEL H. SOLOMON

ABSTRACT.

A case of tuberculous osteomyelitis of the proximal humerus is described. The relevant literature is reviewed with attention to epidemiologic data. Issues highlighted include the frequent presentation in a subacute course without systemic illness; the value of plain radiography and especially magnetic resonance imaging; the importance of obtaining a tissue diagnosis; and the high rate of cure with medical therapy. Although rare in Western countries, skeletal tuberculosis is not uncommon in endemic areas and in migrants from such areas. With the growing use of biologic therapies, rheumatologists must be familiar with the diagnosis and treatment of tuberculosis in all its forms. (J Rheumatol 2003;30:851-6)

Key Indexing Terms:

OSTEOMYELITIS
OSTEOARTICULAR TUBERCULOSIS
TUBERCULOSIS
SHOULDER PAIN
HUMERUS

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From the Division of Rheumatology, Immunology, and Allergy, and Division of Infectious Diseases, Department of Medicine; and the Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Dr. Monach is supported by National Institutes of Health Training Grant T32AR0753010.

P.A. Monach, MD, PhD, Fellow in Rheumatology; D.H. Solomon, MD, MPH, Instructor in Medicine, Division of Rheumatology, Immunology, and Allergy; J.P. Daily, MD, Instructor in Medicine, Division of Infectious Diseases; G. Rodriguez-Herrera, MD, Fellow in Bone Radiology, Department of Radiology.

Address reprint requests to Dr. P. Monach, Rheumatology Department, B3, Brigham and Women's Hospital, 45 Francis Street, Boston, MA 02115. E-mail: pmonach@partners.org

Submitted April 8, 2002; revision accepted September 18, 2002.

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