Tuberculous Osteomyelitis

 Usually young adults or children

Pott's disease:
 Involvement of spine (thoracic / lumbar)
 Extensive necrosis of intervertebral discs with extension into soft tissue
 May produce significant deformities or neurologic deficits
 Difficult to treat
Clinical features
 In US, due to immigrants and immunosuppression
 1 - 3% with tuberculosis have bone infection, usually from focus of acute visceral disease, direct
extension or lymphatics
 Rarely causes inguinal mass with fluctuant psoas abscess
 In AIDS patients, bone infection usually multifocal
 Advanced cases are associated with cutaneous sinuses, which cause secondary bacterial infections
 Associated with fusion of joint, denudation of cartilage, sequestra of medullary cavity
 Can detect in synovial fluid by culture and examination
Sites
 Vertebrae, hip, knee, ankle, elbow, wrist
 Usually involves synovium, epiphysis or metaphysis
Radiology images

Cervical vertebrae
paraspinal tuberculous
abscess MRI
Gross images
 Tuberculous
vertebral
osteomyelitis
(Pott disease)
Microscopic (histologic) images

Differential diagnosis
 Foreign body granuloma post-surgery

Pyogenic Osteomyelitis
 Infection of bone (osteitis) or bone marrow space (myelitis) = osteomyelitis
 Usually pyogenic, fungal or tubercular
 HIV+ patients may be infected by unusual organisms (eg. Mycobacterium avium)
 Radiographically may resemble a neoplasm, particularly after antibiotic treatment
 Severe osteomyelitis is not associated with grade IV sacral decubitus ulcers in non-septic patients;
imaging may be misleading
 May cause secondary AA amyloidosis
Clinical images
Syphilis
 Caused by Treponema pallidum and T. pertenue (yaws)
 Bone involvement more common in congenital syphilis); appears at 5th month of gestation in areas of
active endochondral ossification (osteochondritis) and periosteum
 Acquired syphilis involves bone in tertiary phase, usually nose, palate, skull, tibia, vertebrae, hands /
feet
 Xanthogranulomatous osteomyelitis

 Radiology description
 Permeative, destructive lesion with periosteal new bone formation
 Chronic osteomyelitis: may produce focal destruction or focal abscess
 Syphilis: reactive periosteal bone deposition (“saber shin” of tibia)
Radiology images
 Metatarsal Xray
Gross description
 Syphilis: bone destruction and production; necrotic, well defined bone defects of cortex and
periosteum surrounded by sclerotic bone
Microscopic (histologic) description
 Syphilis: edematous granulation tissue, plasma cells, granulomas, necrotic bone and new bone
production
 Xanthogranulomatous osteomyelitis: prominent foam macrophages arranged in a mosaic pattern with
neutrophil infiltration, foam cell formation, numerous plasma cells, fibrin precipitates
Microscopic (histologic) images