Atypical presentation of septic hip arthritis with tuberculosis

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Background: Mycobacterium tuberculosis is a rare form of septic arthritis, it remains the major cause of skeletal infection in developing area. Tuberculosis mainly involves the large weight- bearing joints particularly hips, knees and ankles. We describe one of the rarest cases of isolated tuberculosis septic hip without involvement of pulmonary and other extrapulmonary manifestations. Case report: A 15 years old Saudi girl was referred to our hospital with compline of chronic hip pain not response to regular analgesia. The patient becomes unable to bear weight in which she uses a wheelchair. There is no history of trauma. She denied any history of fevers, chills, cough, weight loss, or pulmonary symptoms. There is no history of travel, no history of contact with sick people no history of contact with people who prove to be positive with tuberculosis. She receive all vaccines since birth. Radiological investigation with Acid Fast Bacilli and TB PCR show tuberculosis septic hip. She underwent Arthrotomy and we start Anti TB medication. Conclusion: This case shows the importance of constant care and methodical approach to help ease the early diagnosis of tuberculosis septic arthritis. In all cases of septic arthritis, especially when there is no obvious cause, tuberculosis should be suspected and maintained. Investigations should include a chest radiograph, tuberculin test, microscopy for acid-fast bacilli, and culture for Mycobacterium tuberculosis. And to minimize the delay of diagnosis, a synovial biopsy is suggested to be taken at the initial arthroscopic washout, and request histology.