Tuberculosis of the shoulder: ‘Caries sicca’
The following case has been reported in the International Journal of Medical Research.

A 22 yr old male presented with gradually progressive painful swelling and restricted movements in the left shoulder since last five months. Local examination revealed muscle wasting as well. The radiograph showed the typical Phemister's triad (lysis in greater tuberosity of humerus, perilesional osteopenia and reduced joint space).

Magnetic resonance imaging revealed soft-tissue collection in the subacromial and subdeltoid bursae and marrow oedema in humeral head. The erythrocyte sedimentation rate (ESR) was 65 mm/h, and C-reactive protein was 14.26 ng/ml. Aspiration revealed thick, yellow coloured, caseous material, histopathologically consistent with tuberculosis with the presence of Langhans giant cells and epithelioid granuloma.

Pain and swelling responded to anti-tubercular therapy (three months of isoniazid, rifampicin, pyrazinamide and ethambutol followed by six months of isoniazid and rifampicin) with an improved range of motion. The local radiograph also showed improved osteopenia and decreased soft-tissue shadow.

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