Ali M, Raza A, Jamal B.
Symmetrical lytic lesions in Ulna: unusual presentation of multifocal Osteoarticular Tuberculosis.
J Pak Med Assoc Jan ;54(6):339-40.

A 25 year old female presented with pain and restriction of movements in her both elbow joints for the last 4 months. According to her, pain at the elbow joints gradually increased over this period and now she was finding it difficult to carry out her routine work. She had swelling mainly over the olecranon process of both ulna which had gradually increased in size. She also had pain in her right mid foot. There was history of low grade fever, which usually occurred in the evening hours. On clinical examination, there was swelling over both olecranon processes. Swellings were soft and fluctuant and overlying skin was normal. Right elbow had fixed flexion contracture of 15 degree and range of movement from 15 to 135 degrees and left elbow had fixed flexion contracture of 10 degree and range of movement from 10 to 135 degrees with mimimal pain on movement of both elbows. There was mild tenderness on right mid foot with no other abnormality. Chest examination was unremarkable. Radiology showed symmetrical lytic lesion in olecranon process of ulna on both sides. Isotope scan showed increased uptake in both elbows and right intermediate cuneiform bone. Curretings of right olecranon taken under general anesthesia were reported as chronic granulomatous lesion, consistent ith tuberculosis. Patient responded to nine months multidrug antituberculous therapy and has regained full range of movement in both elbow joints.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com