Published: 2017-01-04

Tubercular myositis of infraspinatus: a rare clinical entity

Vikas Verma, Yogesh Kumar Yadav, Anuj Rastogi, Farid Mohammed


Tuberculosis of the musculoskeletal system is generally confined to bones and joints. The surrounding soft tissue is secondarily infected. Tuberculous bursitis, tenosynovitis and primary pyomyositis are rarer manifestations of the disease. Of these, primary tuberculouspyomyositis is probably the rarest entity. We report a case of tubercular myositis of infraspinatus in an 8 year-old female who presented with pain, low grade fever, weight loss, anorexia, progressively increasing pain in the scapular region and restriction of movements. There was no history of trauma, diabetes, immunosuppression, corticosteroid usage, or renal failure. History of contact was present. Tenderness was present along the medial border of scapula and movements of upper extremity requiring movement of the scapula were painful and grossly restricted. MRI of the scapulothoracic region and shoulder revealed small amount of fluid along medial border of scapula with T2 hyperintensity of infraspinatus. Histopathology showed caseous necrosis, inflammatory cells and granulomatous cells suggestive of tuberculosis. Polymerase Chain Reaction for Mycobacterium tuberculosis was found to be positive. Patient was started on four-drug antitubercular treatment and regular dressings. The patient’s general condition improved and at 4 weeks post starting ATT, there was no pain and the patient was able to perform complete range of movement. This is probably the first reported case of tubercular myositis of infraspinatus in an immunocompetent patient without any identifiable focus elsewhere in the body. Rarity of the condition, presence of characteristic findings on MRI and histopathology make the case illustrative for young Orthopaedics surgeons.



Tuberculosis, Myositis, Infraspinatus

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Gayathri Devi DR, Gowri M, S. Padmalatha, Sreeja S, Babu S. Atypical presentation of Mycobacterium tuberculosis. Indian J Pediatr. 2010;77:1440-2.

Wang JY1, Lee LN, Hsueh PR, Shih JY, Chang YL, Yang PC. Tuberculous myositis: a rare but existing clinical entity. Rheumatology. 2003;42:836-40.

Bhatty SM, Prakash JS, John B. Primary tuberculous abscess of vastus lateralis muscle. JK Scienc.e 2011;13(1):37-8.

Batra S, Ab Naell M, Barwick C, Kanvinde R. Tuberculous pyomyositis of thigh masquerading as malignancy with concomitant flexor tenosynovitis and dactylitis of the hand. Singapore Med J. 2007;48:1042-46.

Petter CK. Some thoughts on tuberculosis of fascia and muscle. Lancet. 1937;57:156-9.

Narang S. Tuberculous pyomyositis of forearm muscles. Hand. 2009;4:88-91.

Sen RK, Tripathy SK, Dhatt S, Saini R, Aggarwal S, Agarwal A. Primary tuberculous pyomyositis of forearm muscles. Indian J Tuberc. 2010;57:34-40.

Brussaud DR, Canlorbe P. Vaccine associated tuberculosis in children. Arch Fr Pediatr. 1951;8:49-50.

Dixit R, Dixit K, Shah H, Shah K. Tuberculous abscess of rectus abdominis muscle. Indian J Tuberc. 2004;51:231-3.

Ahmed J, Homans J. Tuberculosis pyomyosits of the soleus muscle in a fifteen-year-old boy. Pediatr Infect Dis J. 2002;21:1169-71.

Sridhar C, Seith A. Tuberculous pyomyositis of temporalis muscle. Eur J Rad Extra. 2004;52:89-91.

Abdelwahab IF, Kenan S. Tuberculous abscess of brachialis and biceps brachii muscles without osseus involvement. J Bone Joint Surg. 1998;80:1521-4.

Puttick MPE, Stein HB, Chan RMT, Elwood RK, How AR, Reid GD. Soft tissue tuberculosis: a series of 11 cases. J Rheumatol. 1995;22:1321-5.

Kim JY, Park YH, Choi KH, Park SH, Lee HY. MRI of tuberculous pyomyositis. J Comput System Sci. Assisted Tomography. 1999;23(3):454-57.

Masood S. Diagnosis of tuberculosis of bone and soft tissue by fine-needle aspiration biopsy. Diagnostic Cytopathology. 1992;8(5):451-5.

Wang WY, Lin FC, T Tsao, Lu J. Tuberculous myositis: an unusual presentation of extrapulmonary tuberculosis. J Microbiol Immunol Infect. 2007;40(1):79-82.

Abdelwahab IF, Bianchi S, Martinoli C, Klein M, Hermann G. Atypical extraspinal musculoskeletal tuberculosis in immunocompetent patients. Part II. Tuberculous myositis, tuberculous bursitis and tuberculous tenosynovites. Can Assoc Rad J. 2006;57:278-86.