Extra-Pulmonary Tuberculosis Presenting as Established Non Union Tibia Shaft Fracture

摘要

Extra-pulmonary tuberculosis (EPTB) is a great mimicker as it can present extraordinarily as a non-resoluting inflammatory pathology or can even mimic as malignancy especially sarcomatous or metastatic deposits. It sometimes can be diagnostically challenging for both the treating clinician and pathologist. The present case report documents a 47-year- old male agricultural worker who was immunocompetent and showed no signs and symptoms of pulmonary tuberculosis. His intradermal tuberculin sensitivity test was also negative. He presented with non-union of right tibia shaft fracture. A modified technique was employed i.e. of doing Fine needle aspiration cytology (FNAC) with Sahli’s bone marrow aspiration needle from the non-united ends of the tibia shaft. This led to the documentation of caseating granulomas and later on positive Ziehl-Neelsen (ZN) staining confirmed the diagnosis of EPTB.The case is worth reporting because of the unusual presentation of EPTB as non union with involvement of marrow and how a systemic approach with cytology and microbiology can lead to a quick and confirmative diagnosis, thus avoiding open biopsies which are not only expensive for the patient but are also associated with a share of morbidity.