Multifocal tuberculous osteomyelitis in a 3-year-old child

Multifocal skeletal tuberculosis accounts for less than 1% of all tuberculous lesions in children. A 3-year-old unimmunised child presented with painless symmetrical swelling of both arms, pallor and hepatosplenomegaly. A skeletal survey demonstrated lytic lesions of the metadiaphysis of both humeri, a rib and the sacrum. The possibility of Langerhans cell histiocytosis or multifocal fibrous dysplasia was considered; however, acid-fast bacilli were detected in the biopsy specimen and real-time polymerase chain reaction confirmed Mycobacterium tuberculosis infection. Culture for M. tuberculosis was negative. The patient responded to anti-tuberculous therapy.