SICOT Online Report E056 Accepted March 8th, 2004 1 TB or not TB? That should be the question SH Liyanage, CM Gupte (), A Cobb, MC Beverly Department of Orthopaedics Ealing University Hospital Uxbridge Rd, Southall, Middlesex UB13HW United Kingdom Correspondence: CM Gupte e-mail: c.gupte@imperial.ac.uk Introduction In the first half of the twentieth century Tuberculosis (TB) was a common and often fatal disease. Advances in radiological diagnosis and antibiotics then led to the decline in all forms of TB in developed countries [11]. With fewer cases diagnostic thresholds inevitably altered. Consequently, there has been resurgence in the incidence of TB. Noted cases have increased from 5000 to 7000 in England and Wales since 1987 [5]. London in particular has seen TB double in the past decade, and now accounts for more than 40% of UK cases [5]. Skeletal involvement occurs in approximately 1-2% of patients with TB [2]. We report on three patients with different forms of skeletal TB – spondylitis, arthritis and osteomyelitis, in the hope of stimulating a high index of suspicion to facilitate early diagnosis. Case 1 A 23 yr old site worker presented to the casualty with a four-week history of left knee pain and swelling associated with fevers. He had immigrated to the UK from India one year