Plain radiography showed the right elbow joint and the adjacent bones to be intact. Magnetic resonance imaging demonstrated signal intensities consistent with a large soft-tissue mass that appeared to be within the brachialis and biceps brachii muscles. A radiograph of the chest revealed normal findings. Histological examination of the soft tissues showed caseous necrotizing epithelioid granulomata. Mycobacterium tuberculosis grew on culture of a specimen of the tissue.

After the introduction of antituberculous chemotherapy, the prevalence of tuberculosis in Europe and North America declined considerably. However, we have since noted an increase in the number of patients in North America who have tuberculosis, independent of those who have the disease in association with acquired immune deficiency syndrome. In Europe and North America, the disease is usually caused by Mycobacterium tuberculosis, which affects the lungs primarily in most patients. Although the infection is presumed to spread to the musculoskeletal system through a focus, the prevalence of active pulmonary tuberculosis coexisting with musculoskeletal tuberculosis has been about 29 per cent (147 of 499). In addition to pulmonary tuberculosis, rare manifestations of the disease, such as tuberculous tenosynovitis (which had not been reported for decades), have begun to appear.

Osteoarticular tuberculosis of the extremities is the second most common type of tuberculosis, after tuberculous spondylitis. The typical radiographic features of osteoarticular tuberculosis are metaphyseal or epiphyseal reactive lesions that lack sclerosis, sequestration, or periosteal reaction and involve the adjacent joint space. A triad of radiographic findings - juxta-articular osteoporosis, peripherally located osseous erosions, and gradual narrowing of the cartilage space (the Phemister triad) - is characteristic of tuberculous arthritis.

Abdelwahab, I. F.; and Kenan, S.: Tuberculous abscess of the brachialis brachii muscles without osseous involvement. A case report. J Bone Joint Surg [Am] 80-A: 1521-4, October 1998.

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