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Backache with its many causes continues to present a challenge to the examining physician. Careful history taking, inspection and palpation still have an essential role, as well as the most modern imaging techniques. Although extra-pulmonary tuberculosis (TB) has shown a disproportionate increase in recent years,1muscular TB is still uncommon. Necropsies of 2224 TB cases revealed only four with TB myositis.2 Petter3 put the incidence of TB myositis at 0.015%. Here we present one of the rare manifestations of TB infection.
Case report
A 46 years old Indian woman was referred to the Department of Rheumatology with a four month history of pain around the right lower rib cage posteriorly. Use of the right upper limb was said to have aggravated the pain, but there were no pleuritic features. She denied sweating, cough, haemoptysis or loss of appetite. Otherwise the patient was in good health without any weight loss. Past history included two episodes of mechanical low back pain in 1970 and in 1995. Both mother in law and brother in law had TB, more than 30 years and eight years ago respectively. They all lived in separate houses. There was no history of recent TB contact or BCG inoculation with the exception of the patient having visited India three years previously. The patient had lived in England for 30 years. There were no known risk factors for HIV infection.
On examination …