Osteomyelitis is an infection of the bone marrow, whereby a bone undergoes inflammatory destruction to create lesions, usually starting in the cancellous or spongey bone of the metaphyses of long bones. Early symptoms usually present as localised pain and swelling to the soft tissue and bone in the affected area and as infection progresses. This can also lead to discharging sinuses caused by the infection of an underlying structure. Osteomyelitis is caused by non-specific bacterial infection and as such is not specific to tuberculosis. Confirmation of the TB infection would have come from diagnosis of primary infection; bacteriological lab tests from sinus of abscess discharge or a positive mantoux or tuberculous skin tests. As with most other extra-pulmonary forms of tuberculosis, osteomyelitis would have been the result of haematogenous spread, through the blood stream.

Initial radiographic indicators of tuberculous-osteomyelitis can include the presence of soft tissue swelling and localised osteopenia, a depletion of protein and mineral content in the bone tissue, but often do not appear in the early stages of infection. In later stages images may also show lesions in the bone and periostitis, new bone formation.

Tuberculous-osteomyelitis not involving a joint predominantly affects the bones of the leg, with the proximal femur and distal tibia being the most common. There are different variations of osteomyelitis; cystic which usually presents as a single lesion; multifocal which can incorporate numerous lesions in one area or may present in several bones and dactylitis which affects the hands and feet. Both cystic osteomyelitis and dactylitis are more common in children.

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