Tuberculous Osteomyelitis of the Hyoid Bone: A Case Report

Skeletal tuberculosis is a well-known disease entity. We report the first case involving hyoid bone and the use of polymerase chain reaction-based test in detection and management. A 62-year-old male presented with neck swelling of a 20-day duration along with change of voice and dysphagia. Examination revealed a cystic, osteolytic lesion of the hyoid bone which histopathologically demonstrated features of granulomatous infection. A polymerase chain reaction test confirmed the diagnosis of tuberculosis. 1. Introduction Tuberculosis (TB) is a chronic bacterial disease of the old and young alike affecting at least nine million of the world population annually of which one fifth are reported from India alone [1]. Extra pulmonary TB accounts for about 10 percent of these cases. Skeletal tuberculosis refers to involvement of the bones and/or joints and accounts for about 10% of the extra pulmonary cases. Tuberculosis osteomyelitis can occur in virtually any bone, including the ribs, skull, phalanx, pelvis, and long bones and is usually multimodal in origin. Spinal TB has been identified in the Egyptian mummies dating back to 9000？BC [2, 3]. Tuberculosis of bone and joints is most often secondary to lung contamination which spreads via haematogenous dissemination. The spine is most often affected, followed by the hips and the knees. Tuberculosis manifestations in the head and neck usually present as cervical lymphadenopathy followed by laryngeal involvement [4]; however involvement of the hyoid bone has not been reported so far in the literature. We report a case of isolated TB hyoid in view of the diagnostic dilemma posed by its presentation. An informed consent was taken from the patient. 2. Case Report A 62-year-old man presented with history of a left-sided neck swelling for 20 days which was progressive in nature associated with odynophagia and hoarseness. He gave history of chronic nonproductive cough for three months with loss of appetite. There was no history of fever or hemoptysis. His past history was insignificant except for a residual left hemiparesis due to a cerebrovascular accident 7 years ago. Examination revealed an ill-defined swelling on the left anterior aspect of the neck, approximately 4 3？cms which was cystic, fluctuant, and nontender. There were no palpable neck nodes, and oral cavity was normal. Flexible nasal endoscopy (Olympus flexible endoscope) revealed a normal laryngopharynx except for a mucosal swelling on the left side of vallecula. A provisional diagnosis of neck abscess was made. We aspirated the abscess with an 18G needle