Tubercular cold abscess of scapula: A rare presentation

Abstract

Tuberculosis (TB) is a very common cause of morbidity and mortality as an infectious disease in endemic areas. Only 18 cases of scapular TB have been reported in the literature so far. In this case report, a patient was reported with tuberculosis of scapula without other typical manifestations of TB. A 54-year-old male presented with a painful progressive swelling of the left scapula for the past 6 months. The swelling was insidious in onset and progressed gradually and associated with a low grade intermittent fever. There were associated constitutional symptoms such as loss of appetite, loss of weight and non-productive cough. Erythrocyte sedimentation rate (ESR)levels were elevated and Mantoux test was positive. A plain radiograph of the chest was done which is normal. MRI findings were suggestive of Koch’s pathology. Incision and drainage of the swelling was undertaken which resulted in evacuation of copious amount of pus. Pus for TB culture revealed no growth of acid-fast bacilli (AFB) after 6 weeks. Final report of AFB fluorescent culture revealed growth of Mycobacterium tuberculosis complex. The patient was started on ATT regimen. On one year follow up, he is completely asymptomatic with ESR levels and total leukocyte count being within normal limits. Tuberculosis of the scapula is a rare presentation.Tubercular cold abscess should also be kept in mind when a person from a TB endemic area, presents with painful swelling of scapula with or without the associated constitutional symptoms of TB.

Keywords

• tuberculosis
• tubercular cold abscess
• scapula