case_images: PMC8343840_01
case_images: Hip anterposterior radiograph of a 14-year-old patient. In the right hip region, a lesion of the greater trochanter with surrounding reactive sclerosis of the lateral aspect, and without periosteal reaction is visible. Soft tissue edema is present around the right greater trochanter.
case_images: JDRS-2021-32-2-536-541-F1.jpg
case_images: PMC8343840_01_JDRS-2021-32-2-536-541-F1.jpg
case_images: F1
case_images: Hip radiographs revealed a lytic lesion within the greater trochanter with partial reactive sclerosis (Figure 1).
case_images: Intraoperative photographs. (a) Right thigh from lateral side - a long subfascial cutaneous fistula going from the middle third of the thigh to the greater trochanter region is visible; (b) Completely excised fistula and affected bursa before sending to pathology.
case_images: JDRS-2021-32-2-536-541-F2.jpg
case_images: PMC8343840_01_JDRS-2021-32-2-536-541-F2.jpg
case_images: F2
case_images: The fistula was marked with a probe, and a detailed exposure showed a subfascial fistula connected to the enlarged trochanteric bursa (Figure 2a). TB was suspected and the material was taken for acid fast laboratory diagnostics. The fistula and trochanteric bursa were excised completely and sent to pathology (Figure 2b). 
case_images: Microscopic analysis of trochanteric bursa biopsy showing ill-circumscribed granulomas composed of epithelioid and multinuclear cells and some mononuclear cells in the stroma. Some multinuclear cells are of Langhans type. Surface of the specimen is partly ulcerated with preserved synovial cells denoted by arrow. (H-E, x100).
  Down arrow-multinuclear giant cell of Langhans type, up arrow-poorly formed granuloma composed of epithelioid cells, left arrow-mononuclear inflammatory cells, right arrow-synovial cells on the surface.
case_images: JDRS-2021-32-2-536-541-F3.jpg
case_images: PMC8343840_01_JDRS-2021-32-2-536-541-F3.jpg
case_images: F3
case_images: The specimen was re-reviewed and corrected identified M. tuberculosis and amended the report to possible TB infection (Figure 3).