A rare case of caries sicca right shoulder

¹Department of Orthopedics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India, ²Department of Orthopedics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India

^&Corresponding author
Ankur Salwan, Department of Orthopedics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India

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Caries sicca is the classic dry form of tuberculosis of proximal humerus. Caries sicca is a fairly rare extrapulmonary presentation of bone tuberculosis. It accounts for 0.9 to 1.7 percent of all extrapulmonary tuberculosis cases. A 23-year-old female presented to the orthopaedics outpatient department with complaint of pain and restriction of shoulder movements for 6 months. The patient has no history of tuberculosis previously, but has a history of a family member suffering from pulmonary Koch. On clinical examination there was tenderness over the Greater tuberosity with restricted external rotation, abduction up to 30 degrees with further passive abduction being painful. There was marked wasting of deltoid and other muscles. Patient´s biopsy was taken for histopathology which showed normal morphology of bony trabeculae, fibromuscular and fatty tissue infiltration of chronic inflammatory cells and at places epithelioid granuloma with Langhans giant cells and caseous necrosis which favor the diagnosis of tuberculosis. The patient was started on chemotherapy antitubercular drugs with intensive phase of 2 months and continuation phase of 7 months. During the treatment period the patient was followed up and the satisfactory shoulder movements abduction up to 90 degrees was achieved after 9 months and erythrocyte sedimentation rate (ESR) was considered as a prognostic factor for treatment.

Figure 1: a rare case of caries sicca and its prognosis with chemotherapy; (A) Gross deformity of the humeral head showing periarticular osteopenia, peripheral osseous erosions, gradual narrowing of interosseous space (Phemister's triad); (B) X-ray after 4 months of treatment shows improved humeral head and articulating surface; (C) post-treatment X-ray after nine months of treatment shows improved osteopenia and restoration of the humeral head; (D) post-treatment clinical photo showing normal shoulder contour; (E,F) histopathological picture showing granulomas with caseous necrosis suggestive of tuberculosis