A Rare Clinical Presentation of Multifocal Tuberculous Osteomyelitis of the Right Parietal and Left Calcaneal Bones in an 11-Year-Old Male: A Case Report.

Paediatric multifocal tuberculous osteomyelitis is a rare and severe clinical entity of extrapulmonary tuberculosis. Globally, Mycobacterium tuberculosis (MTB) is the most common cause of necrotising granulomatous inflammation. The diverse clinical presentations of multifocal osteoarticular tuberculosis and its paucibacillary characteristic pose a diagnostic challenge in children. We present the case of an 11-year-old male with painless right scalp swelling and painful left foot swelling, associated with intermittent fever. Clinical exam revealed a discharging sinus in the right parietal region, right anterior cervical lymphadenopathy and localised signs of inflammation over the left calcaneus. The C-reactive protein and erythrocyte sedimentation rate were elevated. The imaging of the skull and left foot showed osteolytic lesions in the right parietal and left calcaneal bones. Cytopathology of the right enlarged cervical lymph node showed necrotising granulomatous inflammation similar to the histopathology report of the left calcaneal lesion biopsy. Although the acid-fast bacilli smear was negative in the bone biopsy of the left calcaneal lesion, the GeneXpert MTB/RIF Ultra test was positive for MTB. The patient had a good clinical response with surgical intervention and an anti-tuberculous multidrug regimen. Tuberculosis should be ruled out in children with multifocal osteolytic lesions.