In the same manner as
syphilis,
tuberculosis (TB) was often called "The Great Imitator". We have to consider not only
malignancies but also TB as a differential diagnosis when we find any tumorous regions. We report herein on a rare case, clavicular
osteomyelitis due to TB. A 72-year-old female, with
diabetic nephropathy, was on maintenance
hemodialysis. She had a fall 2 months prior to admission followed by
pain around her right clavicle. Ulceration occurred in that region a month prior to admission, and CT scan revealed a fracture of the right clavicle with a
tumor surrounding that area. Seven days prior to admission, she went to a neurologist because of
dizziness. MRI of the brain revealed a
tumor in her pons. The physician suspected the
tumor was
metastasis. Needle biopsies revealed only necrotic tissue so the medical oncologist consulted us because they suspected it was caused by
infection of some kind. From the patient's history and the physical examination, we suspected TB
osteomyelitis and grew some more cultures, but only MRSA and E. coli were detected. We administered
vancomycin and
cefmetazole for the secondary bacterial
osteomyelitis. After a month of hospitalization, we found miliary regions on her chest CT and Mycobacterium tuberculosis was grown from the needle biopsy specimen. We started multi-antituberculosis
therapy and the patient had a good prognosis. We report herein on a rare case of clavicular
osteomyelitis due to TB, together with a review of the literature.