Pyrexia of Unknown Origin and Skeletal Tuberculosis

Skeletal tuberculosis is one of the common forms of extra pulmonary tuberculosis of which 50% of the cases are of spinal tuberculosis and the rest are tubercular arthritis or tendinitis or osteomyelitis (3-5). We report a case of “caries sicca” type of osteoarticular tuberculosis of the shoulder joint, who presented to us primarily for pyrexia. She was investigated at outpatient department as well at the time of previous indoor admissions. She presented to us as her fever persisted despite her admissions twice in multi-speciality hospital. Apart from fever, her relatives noticed right frozen shoulder for which Magnetic Resonance Imaging (MRI) was done which showed changes of arthropathy and synovial effusion. Arthrocentesis was positive for Mycobacterium tuberculosis by Cartridge Based Nucleic Acid Amplification Test. The patient was started on anti-tubercular drugs and physical rehabilitation, upon which she improved. Diagnosis can be missed in such a patient presenting as pyrexia of unknown origin without obvious swelling or sinus at the joint. Extra pulmonary tuberculosis can be one of the common causes of patient presenting with pyrexia of unknown origin; tuberculosis of the shoulder joint is even rarer.