Abstract
Musculoskeletal tuberculosis accounts for 1%-3% of all cases of tuberculosis (TB) worldwide with elbow involvement being even less common. The most cases of tuberculous arthritis occur in patients born in and emigrated from endemic regions, especially in patients who are co-infected with human immunodeficiency virus (HIV). We present a rare case of tuberculous septic arthritis of the elbow joint in a 78-year-old African-American female from the United States, with no history of travel abroad. Her presenting symptoms included pain, swelling, and decreased range of motion of the right elbow for six months. She underwent incision and debridement of the elbow joint and was started on empiric intravenous antibiotic therapy for suspected pyogenic septic arthritis. Several weeks later, surgical cultures demonstrated acid-fast bacilli, identified as Mycobacterium tuberculosis (M. tuberculosis) and a four-drug anti-tuberculosis regimen was initiated. Based upon culture results, additional imaging evaluation was undertaken. She did not have any symptoms of a pulmonary disease but was found to be positive for Mycobacterium tuberculosis in sputum cultures and bronchoalveolar lavage. We emphasize the importance of considering a tuberculosis infection in the differential diagnosis of monoarticular arthritis, especially in elderly patients with immune deficient states since early recognition and treatment result in good functional outcomes.
Highlights
Infections due to Mycobacterium tuberculosis (M. tuberculosis) occur worldwide, with humans being the only known reservoir
Extrapulmonary tuberculosis (TB) makes up about 15%-20% of all cases of TB in immunocompetent hosts and 50% in those individuals who are affected with human immunodeficiency virus (HIV) [2]
We are presenting a rare case of a 78-year-old female patient who presented with a presumptive diagnosis of pyogenic septic arthritis, which was later unmasked
Summary
Infections due to Mycobacterium tuberculosis (M. tuberculosis) occur worldwide, with humans being the only known reservoir. A 78-year-old African-American female presented to the hospital with complaints of worsening right elbow pain and swelling for six months She described the pain as a dull ache that worsened with movement and, over time, was unable to fully move the arm. Blood cultures were drawn and the patient was started on intravenous vancomycin and piperacillin-tazobactam for presumptive pyogenic septic arthritis She underwent incision and drainage of the right elbow after an unsuccessful attempt at arthrocentesis. Final culture results confirmed the presence of the Mycobacterium tuberculosis complex and susceptibilities revealed a non-resistant MTB strain She was evaluated for disseminated disease with a CT chest, abdomen, and pelvis. At a fourmonth follow-up visit, the patient showed significant improvement in her symptoms
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