A Rare Case of Tuberculous Osteomyelitis in a Toddler: Diagnostic Clues and Management Approach

Tuberculous osteomyelitis of the proximal tibia is an extremely rare condition in pediatric patients, often presenting as chronic pain, swelling, and nonspecific symptoms that mimic pyogenic osteomyelitis or bone tumors. We report the case of a three-year-old boy who presented with localized swelling and pain in the right proximal tibia for the past 1.5 months. A plain radiograph revealed lytic lesions with marrow involvement, and a biopsy confirmed granulomatous inflammation with caseous necrosis. The patient was diagnosed with tuberculous osteomyelitis and was started on standard anti-tubercular therapy. Significant clinical and radiological improvement was noted on six-monthly follow-up. This case highlights the importance of maintaining a high index of suspicion for skeletal tuberculosis in endemic regions, even in atypical presentations. Early diagnosis and treatment are critical to prevent complications such as growth disturbances, deformities, and joint involvement, ensuring positive outcomes in pediatric patients.