Tuberculous Osteomyelitis of the Coracoid Process Presenting as Shoulder Pain: A Case Report.

Abstract

Introduction: India accounts for more than 25% of the global cases of tuberculosis (TB). Skeletal TB accounts for approximately 15% of extra-pulmonary TB cases and up to 5% of all TB cases. Spine is the most common site for osteoarticular TB accounting for half of the total osteoarticular TB cases. TB osteomyelitis of flat bones such as the scapula is uncommon. The risk of TB among healthcare workers is significantly higher as compared to the general population. This is of particular concern, especially in endemic countries.

Case report: A 26-year-old doctor presented with a 1-month history of dull-aching right shoulder pain without constitutional symptoms. The patient had tenderness over coracoid process on deep palpation with no other positive findings. Plain radiographs were unremarkable but magnetic resonance imaging revealed osteomyelitic changes in the coracoid process which was confirmed as TB on histopathology. The patient had excellent outcome after 18 months of anti-tuberculous therapy.

Conclusion: A high index of suspicion of TB is imperative in endemic countries, especially in healthcare workers, irrespective of the immunity, vaccination status, and radiographic appearance. Early diagnosis and timely treatment give excellent functional outcomes.