Avascular necrosis of humeral head in an elderly patient with tuberculosis: a case report

A 60-year-old Indian man presented with diffuse swelling and pain in the left shoulder for the previous 6 months. A computed tomography scan of the left shoulder revealed crescentic lucency in the humeral head, suggestive of osteonecrosis. Fine needle aspiration cytology smears from the swelling showed features of an acute suppurative lesion. Stain for acid-fast bacillus was positive and thus, a final clinico-pathological diagnosis of osteonecrosis of humeral head with tubercular etiology was rendered. The patient was initiated on anti-tuberculous therapy with symptomatic improvement in his condition.Osteonecrosis, a debilitating disease, may rarely occur due to tuberculosis, especially in endemic areas. Fine needle aspiration cytology is an effective and inexpensive modality for an early diagnosis of the tubercular etiology of osteonecrosis.Osteonecrosis, also known as avascular necrosis (AVN), occurs in people with risk factors such as high-dose corticosteroid therapy, excessive alcohol intake, injury, malignancy, systemic lupus erythematosus, and hematologic disorders such as sickle cell disease [1]. Among infectious causes, Human Immunodeficiency Virus (HIV) and meningococcemia have been reported to cause AVN [2,3]. However, AVN in association with tuberculosis has been reported in only a few cases [4,5]. In one case, described by Cheung et al. in 1995, polyarticular tuberculosis with AVN was identified in a HIV positive patient [4]. No case of monoarticular tuberculosis associated with AVN has been reported in the available literature.Our case depicts a rare association of monoarticular tuberculosis with AVN in an immunocompetent patient.A 60-year-old man, Indian by origin, presented with swelling and pain in the left shoulder of 6 months duration. There was associated anorexia and loss of weight. However, there was no history of preceding trauma, corticosteroid therapy or significant medical or surgical treatment. He was a non-alcoholic and non-smoker.On local