case_images: PMC8650667_01
case_images: Location and macroscopic view of lesion anterior to shoulder.
case_images: JDRS-2021-32-3-786-791-F1.jpg
case_images: PMC8650667_01_JDRS-2021-32-3-786-791-F1.jpg
case_images: F1
case_images: A physical examination revealed a yellow-brown swollen nodular lesion with a necrotic surface and lobular contour, located on the anterior part of the shoulder joint, approximately 7.5 cm in size (Figure 1).
case_images: Preoperative T1-weighted images of affected shoulder. (a) Coronal view. (b) Sagittal view. (c) Axial view.
case_images: JDRS-2021-32-3-786-791-F2.jpg
case_images: PMC8650667_01_JDRS-2021-32-3-786-791-F2.jpg
case_images: F2
case_images: However, MRI was inadequate to clearly identify whether the fluids were infected (Figure 2). 
case_images: Postoperative anteroposterior direct radiography of affected shoulder.
case_images: JDRS-2021-32-3-786-791-F3.jpg
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case_images: F3
case_images: The remaining bone stock after surgery was evaluated on postoperative Day 15 by direct radiography (Figure 3).
case_images: Surgically removed lesion and macroscopic view of sinus tract.
case_images: JDRS-2021-32-3-786-791-F4.jpg
case_images: PMC8650667_01_JDRS-2021-32-3-786-791-F4.jpg
case_images: F4
case_images: On the cut surface, irregularly delineated white confluent foci were visible (Figure 4).
case_images: Granulomas composed of epithelioid cells, a few giant cells, and lymphocyte cuffs (H-E, x40).
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case_images: PMC8650667_01_JDRS-2021-32-3-786-791-F5.jpg
case_images: F5
case_images: Some granulomas were cuffed by lymphocytes (Figures 5 and 6).
case_images: A large caseating granuloma with palisading epithelioid cells (H-E, x100).
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case_images: PMC8650667_01_JDRS-2021-32-3-786-791-F6.jpg
case_images: F6
case_images: Some granulomas were cuffed by lymphocytes (Figures 5 and 6).
case_images: Acid-fast bacillus staining showing tuberculosis bacilli (black arrows) in giant cells and histiocytes (x600).
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case_images: PMC8650667_01_JDRS-2021-32-3-786-791-F7.jpg
case_images: F7
case_images: TB bacilli in the necrotic areas and histiocytes (Figure 7); however, there was no reproduction in the joint fluid culture. The TB treatment was initiated by consulting with the Department of Infectious Diseases and Clinical Microbiology.
case_images: Anteroposterior direct radiography of affected shoulder at final follow-up.
case_images: JDRS-2021-32-3-786-791-F8.jpg
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case_images: F8
case_images: Direct radiographic evaluation of the shoulder joint was made (Figure 8), and joint reconstruction was planned for the end of the medication treatment.