Abstract
A 33-year-old man from Pakistan presented in London with a severely destructive polyarthritis 24 years after onset. Synovial biopsy and culture revealed evidence of tuberculous infection. It is probable that the polyarticular nature of his disease misled clinicians because the concept of tuberculous arthritis perpetuated in rheumatology books is of a mono- or oligoarticular disease. Children and young adults in endemic areas may be especially susceptible to a polyarticular presentation. Awareness of this pattern of illness might prevent similar cases of progressive, disabling illness. The ease of transcontinental travel makes it important that clinicians worldwide maintain a vigil for tuberculosis in obscure cases of polyarthritis deriving from geographic areas of risk.
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