Sinus Tract Formation After Arthroplasty of the Shoulder Secondary to Tuberculosis: A Case Report and Review of the Literature.

Abstract

Since reporting of tuberculosis (TB) first began in the 1950s, Mycobacterium tuberculosis infection rates have steadily declined in the United States; in 2011, the lowest number of TB cases, as well as the lowest rate of infection to date, was recorded1. Of these cases, approximately 60% were in patients born outside of the United States1. Approximately 20% of all cases of TB are extrapulmonary, with 11% involving the bones and/or joints2. Skeletal TB most commonly involves the spine; knee and hip joints are the next most commonly affected areas3. Patients with bone and/or joint TB commonly present with pain, swelling, and/or a draining sinus4-10. These signs and symptoms are common to joint infections from other sources, however, and thus a higher degree of suspicion for TB may be warranted only in the absence of obvious sources of infection. This case report demonstrates the difficulty of making the diagnosis of a TB joint infection, but also provides valuable information for when to suspect TB. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A sixty-two-year-old woman presented to the general orthopaedic clinic with right shoulder swelling and pain. The medical history included scleroderma, with secondary gastrointestinal dysmotility, osteoporosis, and interstitial lung disease. Examination of the right shoulder demonstrated diffuse soft-tissue swelling and decreased range of motion. Radiographs of the shoulder revealed sclerosis at the greater tuberosity (Fig. 1), and magnetic resonance imaging (MRI) findings showed subacromial bursitis with multiple free loose bodies. Inflammatory marker levels were elevated; the erythrocyte sedimentation rate was 45 mm/h (normal, 0-29 mm/h), and the C- reactive protein level was 3.21 mg/dL (normal, <0.500 mg/dL). Examination under anesthesia followed by diagnostic arthroscopy yielded multiple loose bodies …