An uncommon cause of sciatic pain: tuberculous osteomyelitis of the ischial tuberosity

Tuberculosis of ischial tuberosity as a rare cause of gluteal pain: A case series of 9 patients with review of literature

BACKGROUND

Osteo-articular Mycobacterium tuberculosis infection of the ischial tuberosity is a rare cause of gluteal pain.

METHODS

A retrospective clinico-radiological review of nine patients with Mycobacterium tuberculosis infection of the ischial tuberosity was undertaken. The spectrum of presenting features, diagnostic challenges, radiological findings with particular emphasis on Magnetic resonance imaging (MRI) and clinical course was reviewed.

RESULTS

All the 9 patients (5 male: 4 female) aged between 8 and 50 years of age (mean 15.3 years) developed insidious onset of buttock pain over a period of weeks to months with difficulty in walking. Microbiological and/or histopathological confirmation of Mycobacterium tuberculosis infection was undertaken in all cases. Complementary MRI revealed diffuse bone marrow signal hypointense or isointense on T1-weighted and hyperintense on T2-weighted and STIR images. MRI was able to provide anatomic details of soft tissue lesions and extensions. MRI illustrated the sinus tract in one patient. Ultrasound imaging allowed diagnostic and therapeutic management of in 3 patients.

CONCLUSION

Tuberculosis of ischial tuberosity can be a rare cause of gluteal pain. Delay in diagnosis could be due to an indolent natural history, unusual presentation and clinical features. A high index of suspicion especially in endemic areas with complementary imaging and microbiological or histopathological confirmation of Mycobacterium tuberculosis infection is necessary for definitive diagnosis. Targeted treatment under the umbrella of Anti-Tubercular Therapy is crucial in achieving successful clinical outcome.

An unusual case of gluteal pain - Case report and review of literature

Numerous pathologies of the spine, pelvis and hips can present with gluteal pain and pose a challenge to orthopaedic surgeons. We report a unique Case of tuberculous osteomyelitis of the ischium in a young immunocompetent individual presenting as gluteal pain. A high index of suspicion, early diagnosis and prompt management is mandatory to promote early and complete healing and prevent complications.