Osteoarticular tuberculosis (OAT) is a clinical condition characterized by a series of pathological manifestations resulting from the invasion of osteoarticular structures in the musculoskeletal system by the Bacillus of Koch (BK), or Mycobacterium tuberculosis. This condition exhibits a higher frequency of involvement in the spine and hips, with the occurrence of tuberculosis in the epiphyses of long bones being extremely rare. The indolent nature of the disease poses a significant challenge for clinicians in accurately diagnosing epiphyseal tuberculosis in long bones. Given the varied clinical and radiological presentations, a diagnosis requires a high level of suspicion, often confirmed through biopsy and culture. This case presentation aims to highlight the uncommon incidence of tuberculosis in long bones. A 53-year-old woman sought medical attention due to chronic leg pain and swelling. Radiological investigations revealed a lytic lesion in the proximal tibia. A minimally invasive biopsy of the lytic lesion followed by curettage and histopathology confirmed the diagnosis of proximal tibia tuberculosis. The patient received medical treatment for nine months using the 2RHZE/7RH protocol (rifampicin, isoniazid, pyrazinamide, ethambutol), with good results at follow-up. This case underscores the importance of considering tuberculosis in cases of epiphyseal lesions in long bones, particularly in regions where the disease is endemic.
