77 TUBERCULOSIS OF THE GREATER TROCHANTERIC BURSA SUSAN REHM-GRAVES, ALLAN J. WEINSTEIN, LEONARD H. CALABRESE, SEBASTIAN A. COOK, and FRANCIS R. S. BOUMPHREY zyx A patient with tuberculosis of the greater tro- chanteric bursa is described, and the clinical and radio- graphic characteristics of the infection are reviewed. Despite the infrequency of skeletal tuberculosis, this infection should be considered in the differential diagno- sis of chronic hip pain. Skeletal tuberculosis is an uncommon disorder. Of the 27,749 cases of tuberculosis reported to the Centers for Disease Control in 1980 (I), fewer than 1% involved the musculoskeletal system. Because of this infrequency, tuberculosis may not be considered dur- ing the evaluation of patients with chronic muscu- loskeletal symptoms. We report a patient with tu- berculosis of the greater trochanteric bursa who demonstrates the importance of a complete medical history and a careful evaluation for tuberculosis in such patients. CASE REPORT A 67-year-old woman was admitted to the Cleveland Clinic Hospital for evaluation of back and hip pain of 30 years' duration which had become more severe during the previous year. The pain was located in the left hip and buttock, radiated to the left foot, and From the Cleveland Clinic Foundation. Susan Rehm-Graves, MD: Department of Infectious Dis- ease; Allan J. Weinstein, MD: Department of Infectious Disease; Leonard H. Calabrese, DO: Department of Rheumatic Disease; Sebastian A. Cook, MD: Department of Radiology; Francis R. S. Boumphrey, MD: Department of Orthopaedic Surgery. Address reprint requests to Allan J. Weinstein, MD, zyxwvut De- partment of Infectious Disease, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH zyxwvutsrq 44106. Submitted for publication June 21, 1982; accepted in re- vised form August 18, 1982. increased on activity. There had been no bowel or bladder abnormalities. The patient had not noted fever or weight loss, but reported that she had experienced chilly sensations. The patient stated that a back problem had been present 40 years earlier. She had developed left ingui- nal swelling and low back discomfort following an episode of pneumonia. Aspiration of the area of swell- ing reportedly yielded tubercle bacilli. The patient had undergone surgery on the lumbosacral spine with implantation of a bone graft from the left hip 40 years prior to admission; she received no antituberculous therapy. On physical examination, temperature was 37"C, pulse was 80 beatdminute and regular, and blood pressure was 100/66. The patient was a healthy- appearing woman in no acute distress. Examination showed the head, eyes, ears, nose, and throat to be normal. The neck was supple and there was no lymph- adenopathy. The thyroid and breasts were normal. Percussion and auscultation showed the lungs to be clear. On cardiac examination, the point of maximum impulse was in the fifth left intercostal space at the midclavicular line. There were no murmurs, rubs, or gallops. Examination of the peripheral arteries and veins revealed no bruits or varicosities. Results of abdominal, rectal, and gynecologic examinations were normal. On musculoskeletal examination, there was no tenderness over the vertebral bodies or paraverte- bra1 musculature. Straight leg raising was normal bilaterally. Examination of the hips revealed a signifi- cant decrease in internal and external rotation of the left, accompanied by pain. There was marked tender- ness on palpation over the left femoral trochanter. Results of the neurologic examination were normal. Arthritis and Rheumatism, Vol. 26, No. 1 (January 1983)