PMC8650667_01
Location and macroscopic view of lesion anterior to shoulder.
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F1
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).
Preoperative T1-weighted images of affected shoulder. (a) Coronal view. (b) Sagittal view. (c) Axial view.
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F2
However, MRI was inadequate to clearly identify whether the fluids were infected (Figure 2). 
Postoperative anteroposterior direct radiography of affected shoulder.
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F3
The remaining bone stock after surgery was evaluated on postoperative Day 15 by direct radiography (Figure 3).
Surgically removed lesion and macroscopic view of sinus tract.
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F4
On the cut surface, irregularly delineated white confluent foci were visible (Figure 4).
Granulomas composed of epithelioid cells, a few giant cells, and lymphocyte cuffs (H-E, x40).
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F5
Some granulomas were cuffed by lymphocytes (Figures 5 and 6).
A large caseating granuloma with palisading epithelioid cells (H-E, x100).
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F6
Some granulomas were cuffed by lymphocytes (Figures 5 and 6).
Acid-fast bacillus staining showing tuberculosis bacilli (black arrows) in giant cells and histiocytes (x600).
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F7
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.
Anteroposterior direct radiography of affected shoulder at final follow-up.
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F8
Direct radiographic evaluation of the shoulder joint was made (Figure 8), and joint reconstruction was planned for the end of the medication treatment.