Rohit Chakravarty, Hirdesh Sahni, Nilanjan Sarkar
Extrapulmonary tuberculosis (EPTB) can mimic pyogenic infection, inflammatory disease, and malignancy. We report the case of a middle-aged female patient who presented with low-grade fever, left hip pain, and left loin pain. Pelvic imaging demonstrated osteomyelitis with an abscess centered in the left femoral neck. An abscess was also present in the left obturator internus muscle. Further abdominal imaging demonstrated left hydronephrosis with a mid-ureteric stricture and retroperitoneal lymphadenopathy. Pus was aspirated and tested positive for Mycobacterium tuberculosis, establishing the diagnosis of tuberculous osteomyelitis with abscess formation and presumptive multifocal extrapulmonary involvement, supported by imaging findings and interval regression. Antitubercular therapy was initiated, and ureteric stenting was performed to relieve the symptoms of urinary obstruction. Follow-up imaging after completion of treatment showed complete resolution of the disease. This case highlights the complementary role of imaging in mapping the multisystem disease burden, guiding microbiological confirmation, and documenting the treatment response.