Tuberculous Arthritis Research Articles

Dorsalgia persistente en varón de 62 años: ¿dolor mecánico?

The case is presented of a 62 year old man with a history of pulmonary tuberculosis, repeatedly consulting his primary care physician for treatment of analgesic / anti-inflammatory resistant back pain, and usually coincided with physical activity. It was initially diagnosed as mechanical pain, but in the absence of response to rest and treatment a magnetic resonance of the spine was requested, which reported bone metastases. The patient was then referred to Internal Medicine for further tests in hospital. The histopathology ruled out the presence of neoplastic cells, and imaging tests showed radiographic abnormalities in vertebral bodies (osteomyelitis-discitis) associated with epidural abscess, compatible with Pott's disease, a kind of tuberculous arthritis of the intervertebral joints.

Bilateral pathological dislocation of the hip secondary to tuberculous arthritis following disseminated tuberculosis

Pathological dislocation of the hip has been reported as a complication in various hip disorders. Several pathomechanisms including capsular laxity, synovial hypertrophy, and acetabular and proximal femur destruction have been described. We report a case of bilateral pathological dislocation of the hip in a 6-year-old girl secondary to tuberculous arthritis following disseminated tuberculosis, which we managed operatively. At the 18-month follow-up, the child had a clinically stable left hip despite radiological subluxation. Bilateral pathological dislocation of the hip associated with tuberculous arthritis is a rare condition and has never been reported in the literature.

Subacromial Bursitis With Giant Rice Bodies as Initial Presentation of Rheumatoid Arthritis

Rice body formation is a nonspecific response to chronic synovial inflammation associated with tuberculous arthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, seronegative inflammatory arthritis, and even osteoarthritis. Such bodies were termed rice bodies because of their close resemblance to grains of polished white rice. We present a case report of a middle-aged woman with right shoulder subacromial/subdeltoid bursitis with giant rice body formation as her initial presentation of rheumatoid arthritis. Her right shoulder symptoms resolved after subacromial and subdeltoid bursectomy and removal of the rice bodies. She subsequently developed inflammatory arthritis of other joints, met the criteria for rheumatoid arthritis, and has been treated medically.

Sea urchin spine arthritis in the foot

We present a case of sea urchin spine arthritis (SUSA) in a 33-year-old woman who sustained penetrating trauma to the interphalangeal (IP) joint of the hallux while snorkeling in Japan. Serial radiographs and MRI were obtained over a period from 7 weeks to 10 months following injury. At 7 weeks radiographs revealed periarticular osteopenia and subtle marginal erosion, similar to the appearance of tuberculous arthritis. Over the ensuing months, radiographs and MRI documented progressive marginal and periarticular erosions with synovitis, despite preservation of cartilage space and restoration of bone mineral density. Delayed radiographs and imaging features mimic gouty arthropathy. Only the history points to the proper diagnosis, which was confirmed by histopathology, demonstrating necrobiotic granuloma with central fibrinoid necrosis following synovectomy and arthrodesis. The majority of previous case reports affected the hand, with few cases in the feet. In all, radiographic illustrations were limited and demonstrated only minimal osteolysis and periosteal reaction. No other report included MRI or serial radiographs over a long period to illustrate the natural progression of the disease.

Glenohumeral tuberculous arthritis complicated with beta haemolytic streptococcus: An extraordinary rare association: A case report

INTRODUCTIONSeptic arthritis of the glenohumeral joint is a rare entity and its diagnosis is difficult with a superadded infection in the presence of underlying tuberculosis. We report the first case of group B beta haemolytic streptococcal glenohumeral arthritis with underlying tuberculosis. CASE PRESENTATIONA 40 year old lady previously diagnosed to have poliomyelitis, rheumatoid arthritis, hepatitis C, and diabetes mellitus for the last 10 years, presented to the emergency room with diabetic ketoacidosis. Two weeks prior to presentation she developed fever along with pain and swelling in left shoulder with uncontrolled blood sugars. Local examination of the shoulder revealed global swelling with significant restricted range of motion. MRI showed a large multiloculated collection around the left shoulder joint extending into the axilla, and proximal arm. Urgent arthrotomy performed and about 120ml thick pus was drained. The patient was started on clindamicin and antituberculous chemotherapy and her symptoms dramatically improved. DISCUSSIONBone and joint involvement accounts for approximately 2% of all reported cases of tuberculosis (TB), and it accounts for approximately 10% of the extra pulmonary cases of TB. Tuberculosis of the shoulder joint constitutes 1–10.5% of skeletal tuberculosis. Classical symptoms of fever, night sweats, and weight loss may be absent, and a concurrent pulmonary focus may not be evident in most cases. CONCLUSIONDespite acute presentation of septic arthritis, in areas endemic for tuberculosis and particularly in an immunocompromised patient, workup for tuberculosis should be part of the routine evaluation.

Tuberculous arthritis of the knee joint mimicking pigmented villonodular synovitis

Tuberculous arthritis is difficult to diagnose early because of its atypical insidious clinical manifestations and non-specific imaging findings. Specifically, monoarticular tuberculosis of the knee may mimic pigmented villonodular synovitis (PVNS). The present report describes a young patient with tuberculous arthritis of the knee. Proper diagnosis was delayed due to magnetic resonance imaging findings, such as hemosiderin deposits and a nodular mass around the knee joint, suggesting the diffuse type of PVNS. These findings suggest that the first step in the diagnosis of tuberculous knee arthritis is to have a high index of suspicion. IV.

Pulmonary tuberculosis and tuberculous arthritis of knee joint associated with rheumatoid arthritis treated with anti-tumor necrosis factor (TNF)-alpha medication: a case report

Tuberculosis infection (TB) is one of the most important problems for the rheumatoid arthritis (RA) patients treated with anti-TNF agents. Pulmonary tuberculosis is the most common clinic form of the TB in these patients. However, tuberculosis arthritis is very rare. We present here a 72-year-old Caucasian woman with seropositive RA, treated with etanercept/adalimumab for the last 2 years, who presented with resistant knee pain and joint effusion. We believe that this treatment caused the tuberculosis in this patient, which is the most worried complication. Interestingly, tuberculosis was in the knee joint at this time.

Tuberculous arthritis revisited as a forgotten cause of monoarticular arthritis

BACKGROUND AND OBJECTIVES:Tuberculosis (TB) continues to be a major concern for health care workers. The number of reported cases of extrapulmonary tuberculosis, particularly osteoarticular tuberculosis, is increasing. This fact is attributed to different factors such as underestimating the disease and difficulty in diagnosis, which requires tissue sampling and can lead to a delay in the diagnosis, and can result in significant morbidity and mortality. The aim of this study was to highlight the difficulties and delay in diagnosis of articular tuberculosis, raising the need to create awareness about the importance of early diagnosis to avoid major complications of joint destruction.DESIGN AND SETTING:Retrospective review of patients presenting to a tertiary care center between 2003 and 2009.PATIENTS AND METHODS:We reviewed cases who presented with monoarticular joint pain and swelling that failed to respond to treatment elsewhere and were eventually diagnosed as having articular tuberculosis. We collected the demographic data, history, data on clinical examination and the relevant laboratory investigations, in addition to the data on radiological studies. All patients were treated medically with antituberculosis chemotherapy and surgically according to the severity of joint destruction.RESULTS:Thirteen patients had a mean age was 40 years (range, 17-70 years). The average delay in diagnosis was 2 years. Only 1 patient had pulmonary TB. The hip, knee and elbow were the most common joints involved. Bacteriology was positive in 69% of the cases; and histopathology, in 92%. Fifteen percent of the patients had arthrodesis. None showed recurrence after follow-up of 4 years.CONCLUSION:A high level of clinical suspicion is essential for early diagnosis and treatment of osteoarticular TB to reduce its significant morbidity.

Application of external fixation in ankle joint arthrodesis

Objective To study the curative effect of external fixation in ankle joint arthrodesis.Methods From January 2001 to June 2009, we used external fixation in arthrodesis for 27 cases of traumatic ankle joint They were 18 males and 9 females, with an average age of 41 years (range, 32 to 68 years) . There were 13 cases of traumatic osteoarthritis of the ankle joint, 3 cases of local kaschin beck disease, 5 cases of ankle osteoarthritis, 2 cases of tuberculous ankle arthritis, 3 cases of ankle replacement failure, one case of osteomyelitis. Fibular flap grafts were used in 8 cases, bone autografts in 11 cases, bone allografts in 2 cases,and combined bone grafts in 11 cases. External fixation was applied for all cases to ensure compressive contact between bone ends. Results The patients were followed up for 6 to 38 months (average, 10 months). No pain or swelling was found at the ankle joint. Significant improvements were made in walking gait and function of the ankle. X-ray films verified bony fusion in all cases. Conclusion External fixation can lead to a high rate of bony fusion of the ankle joint, and is advantageous for treatment of ankle infection and combined deformity of the ankle and foot. Key words: Ankle joint; Arthrodesis; External fixatiors

MR findings of synovial disease in children and young adults: Part 2

Synovium is the thin membranous lining of a joint. It produces synovial fluid, which lubricates and nourishes the cartilage and bone in the joint capsule. Synovial diseases in children can be classified as normal structures as potential sources of pathology (synovial folds: plicae, infrapatellar fat pad clefts), noninfectious synovial proliferation (juvenile idiopathic arthritis, hemophilic arthropathy, lipoma arborescens, synovial osteochondromatosis, pigmented villonodular synovitis, reactive synovitis), infectious synovial proliferation (pyogenic arthritis, tuberculous arthritis), deposition disease (gouty arthropathy), vascular malformation, malignancy (metastasis) and intra-/periarticular cysts and cyst-like structures. Other intra-articular neoplasms, such as intra-articular synovial sarcoma, can mimic synovial disease in children.

Diagnostic utility of enzyme-linked immunospot assay for interferon-γ in a patient with tuberculous arthritis and pyomyositis

The indolent and nonspecific presentations of tuberculous arthritis and pyomyositis render their diagnosis a great challenge for clinicians. We describe a 78-year-old man with swelling and pain of right knee for 6 months. The patient was empirically treated for tuberculosis because positive enzyme-linked immunospot assay for interferon-γ of blood was reported at 2 days after aspiration of synovial fluid, which was negative for acid-fast stain but subsequently grew Mycobacterium tuberculosis 6 weeks later. He recovered uneventfully with 1-year antituberculous combination therapy.

Inverted 'V' osteotomy excision arthroplasty for bony ankylosed elbows

BackgroundBony ankylosis of elbow is challenging and difficult problem to treat. The options are excision arthroplasty and total elbow replacement. We report our midterm results on nine patients, who underwent inverted 'V' osteotomy excision arthroplasty in our hospital with good functional results.MaterialsOur case series includes 9 patients (seven males and two females) with the mean age of 34 years (13-56 years). Five patients had trauma, two had pyogenic arthritis, one had tuberculous arthritis, and one had pyogenic arthritis following surgical fixation.ResultsThe average duration of follow up is 65 months (45 months-80 months). The mean Mayo's elbow performance score (MEPS) preoperatively was 48 (35-70). The MEPS at final follow up was 80 (60-95). With no movement at elbow and fixed in various degrees of either flexion or extension preoperatively, the mean preoperative position of elbow was 64°(30°to 100°). The mean post operative range of motion at final follow up was 27°of extension (20-500), 116°of flexion (1100-1300), and the arc of motion was 88°(800-1000). One patient had ulnar nerve neuropraxia and another patient developed median nerve neuropraxia, and both recovered completely in six weeks. No patient had symptomatic instability of the elbow. All patients were asymptomatic except one patient, who had pain mainly on heavy activities.ConclusionWe conclude that inverted 'V' osteotomy excision arthroplasty is a viable option in the treatment of bony ankylosis of the elbow in young patients.

Synovial Lesions with Low Signal Intensities on T2-Weighted MR Image

Pigmented villonodular synovitis, synovial chondromatosis, long-standing rheumatoid arthritis, hemophilic arthropathy, chronic tophaceous gout, amyloid arthropathy, tuberculous arthritis, and hemangioma are the synovial diseases showing low signal intensity on T2-weighted image. Synovial deposition of hemosiderin, urate, and amyloid and fibrosis or caseous necrosis of hypertrophied synovium are known as the pathologic causes of T2 signal intensity. Because of the low incidence of the synovial lesions showing T2 low signal intensity, recognition of these diseases would be helpful for the exact diagnosis.

Synovial Biopsy Findings among Patients with Monoarthritis

Objective. Any joint disorders can present as monoarthritis initially, which makes the range of differential diagnosis of monoarthritis extensive. Synovial biopsy may play a role in the diagnosis of monoarthritis. We reviewed the synovial biopsy findings of monoarthritis patients in order to assess its diagnostic value. Methods. Synovial pathologic findings of 39 patients who visited the rheumatology or orthopedic surgery clinic for acute or chronic monoarthritis from Feb., 2006 to Jul., 2010 were reviewed retrospectively. Result. Four (10.3%) of 39 patients could be diagnosed with specific arthritis after synovial biopsy (rheumatoid arthritis, tuberculous arthritis, giant cell tumor, and os- teochondroma, each). Conclusion. The result showed that the synovial biopsy is useful for differential diagnosis of monoarthritis in a lim-

Tuberculous Arthritis of the Ankle Associated With Recurrent Ankle Sprain

Tuberculosis of the ankle is an uncommon presentation of extrapulmo-nary infection. The early diagnosis of tuberculous arthritis of the ankle is difficult because of the uncommon site, the ability of tuberculosis to mimic other disorders and, all too common, lack of awareness of this infection by the physician. Here, we report the case of a 14-year-old boy with an unusual presentation of tuberculous arthritis involving the ankle joint. The patient, despite a period of conservative treatment, presented with a localized painful swelling of the ankle associated with recurrent ankle sprain. Tuberculous arthritis was diagnosed through a surgical procedure, and antituberculous therapy eventually eradicated the infection. It is highly recommended that early open biopsy and synovial fluid culture be performed in suspicious cases because early diagnosis is the key to successful treatment.

Tuberculous Arthritis of the Sternoclavicular Joint —A Case Report and Review of Literature—

Tuberculous Arthritis of the Sternoclavicular Joint —A Case Report and Review of Literature—

Early syphilis mimicking tuberculous meningoencephalitis in an HIV-positive patient

A man previously treated for tuberculous arthritis presented with acute meningoencephalitis. Cerebrospinal fluid tests suggested infection with Mycobacterium tuberculosis, but a diagnosis of early neurosyphilis was subsequently made.

Isolated tuberculosis of the lumbar apophyseal joint

Background context Posterior element tuberculosis is rare accounting for only 3% to 5% of all spinal tuberculosis. To our knowledge, no case of isolated facet joint tuberculosis with coronal decompensation has been reported in literature so far. Purpose The purpose of this study was to describe a case of tuberculous arthritis of the lumbar facet joint and its effect on coronal balance of the spine. Study design The study design was a case report. Methods A 14-year-old boy presented with a 3-month history of back pain without radiation and with normal neurological findings. Computed tomography and magnetic resonance imaging showed destruction of the right L4–L5 facet joint with L5–S1 spondylolytic listhesis. Despite 2 months of antitubercular medication after a core biopsy confirmation of L4–L5 facet tuberculosis, there was progression of coronal decompensation of the spine with severe pain. Instrumentation with intertransverse fusion was done as a secondary procedure. Results The patient was completely relieved of symptoms after instrumented fusion along with antitubercular medication. Conclusion Isolated lumbar facet joint tuberculosis is a rare entity with a potential for coronal decompensation of the spine, which makes early instrumented fusion with antitubercular medication a viable treatment modality.

Elbow pain proven to be tuberculous arthritis -A case report-

Elbow tuberculosis is a rare disease which accounts for 1-3% of all cases of osteoarticular tuberculosis. The diagnosis of tuberculous arthritis is very difficult in most clinical situations because of the insidious onset, indolent process, and mild and non-specific local or systemic symptoms. Thus, the confirmatory diagnosis and effective treatment for tuberculous arthritis are delayed until the disease progresses to an advanced stage in many clinical settings. Herein we report a case of septic arthritis of the elbow due to Mycobacterium tuberculosis as a result of misdiagnosis and delayed treatments.

Tibiotalocalcaneal Arthrodesis Using a Supracondylar Femoral Nail for Advanced Tuberculous Arthritis of the Ankle

To review 7 patients with advanced osteoarticular tuberculous arthritis of the ankle who underwent arthrodesis using a supracondylar femoral nail. All patients showed gross destruction of the articular cartilage of the tibiotalar joint with severe periarticular rarefaction on radiographs. Their pre- and one-year post-operative Foot and Ankle Outcome Scores (FAOS) were compared. All patients underwent joint debridement, complete synovial excision, and arthrodesis using a supracondylar femoral nail, followed by multidrug chemotherapy for 12 months (isoniazid, rifampicin, pyrazinamide, and ethambutol for 3 months, and isoniazid and rifampicin for 9 months). All patients achieved fusion in a mean of 13 weeks and regained their preoperative level of independence. No patient had a relapse, major complications, or hardware failure. At postoperative year one, the mean FAOS for pain improved to 85 from 26, whereas the mean FAOS for quality of life improved to 60 from 5. Tibiotalocalcaneal arthrodesis using a supracondylar femoral nail, combined with debridement and multidrug therapy, enabled a reliable one-stage solution for advanced osteoarticular tuberculosis and early return to function.