Title: „TB on the spot” – Discussion on an atypical extra-spinal presentation of tuberculosis from a Late Medieval Hungarian cemetery

Authors: Csilla Libor^1,2, Tamás Hajdu², Loránd O. Kovács³, László Kunos⁴, Orsolya Mateovics-László³

Affiliations: ¹Szent István Király Museum, Székesfehérvár, Hungary; ²Eötvös Loránd University, Budapest, Hungary; ³Hungarian National Museum, Budapest, Hungary; ⁴Pulmonológiai Klinika SE/AOK, Budapest, Hungary

Abstract: Investigations of non-adult remains are particularly suitable for finding epidemic periods in past populations. This study presents a unique example of an osseous manifestation of tuberculosis on a child’s remains from Medieval Hungary.

The Field Service for Cultural Heritage excavated the exceptionally church round cemetery with around 4000 graves of Perkáta – Nyúli-dűlő in Hungary between 2009–2010. The analysed skeleton (SNR 948) was located in the medieval (10–16^th centuries) part of the cemetery.

Besides the standard macroscopic pathological observation, radiographic analysis was also applied.

The remains of the child (13–14-year-old) showed numerous skeletal lesions: the ribs have proliferative lesions (dense nodules) on the visceral surfaces of the shaft and there were some new bone formations on them; lytic lesions occurred with rounded edges on the thoracic and lumbar vertebral bodies and on the facies auricularis of the left ilium, we can see pitting and some new bone formation. The auricular surface almost fully disappeared. What makes this pathological case exceptional is the significant change in the manubrium of the sternum. It showed an extensive osteolytic erosion, probably due to local osteomyelitis, which is a unique phenomenon in an archaeological context.

This rare type of tuberculous osteomyelitis appears in less than 1% of the cases, and even less in case of children according to the modern medical literature. Although some cases of slight lesions of the manubrium have been described from an archaeological context, no such advanced lesion has been published so far.