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Osteoarticular tuberculosis: The great mimicker still catches us out--a case report.

Magnussen A, Amirthanayagam T, Sofat R - Acta Orthop (2015)

View Article: PubMed Central - PubMed

Affiliation: a Department of Trauma and Orthopaedics , Lister Hospital , London , United Kingdom.

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Given the demographics of the patient and the presenting symptoms, there was high clinical suspicion of tuberculosis, which we investigated accordingly... Routine blood tests and radiographs of the chest and elbow did not give a specific diagnosis (Figure 1)... Samples were sent for microscopy and culture, looking specifically for acid-fast bacilli... The final culture results were reported after 8 weeks and were negative... The elbow was painful but not swollen, and there was no indication for further investigation at this stage... As the elbow remained painful and swollen, but with no clinical evidence of intra-articular involvement, the patient was given the diagnosis olecranon bursitis and steroid injections were administered, initially with good response... However, a few months later he returned with worsening pain and reduced range of motion... Due to the previous (negative) culture results, tuberculosis was not suspected... Initial results did not reveal any organisms... As demonstrated by our case, delay in diagnosis of tuberculous arthritis can result in irreversible osteoarticular destruction... Despite our high suspicion of tuberculosis and appropriate first-line investigations, we were falsely reassured by the negative lavage and initially negative aspiration culture... The resulting delay in diagnosis and initiation of definitive treatment led to significant damage to the elbow... In that case, the patient presented with a 3-month history and underwent serial bursal debridements over the course of 4 years before the diagnosis of Mycobacterium tuberculosis was confirmed by extended culture for acid-fast bacilli.

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MRI showed a multi-loculated collection at the distal humerus (upper panel) and the proximal radio-ulnar joint (lower panel). Key: A: ulna; B: radius; C: humerus.
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Figure 0002: MRI showed a multi-loculated collection at the distal humerus (upper panel) and the proximal radio-ulnar joint (lower panel). Key: A: ulna; B: radius; C: humerus.

Mentions: Because of his swollen and inflamed elbow, he was now started empirically on intravenous flucloxacillin. When there was no response to this intervention, magnetic resonance imaging (MRI) of the elbow was performed and revealed a large, multi-loculated collection in continuity with the elbow joint and marked synovial proliferation with bony erosions (Figure 2). These radiological findings gave high suspicion of tuberculosis (Malavia and Kotwal 2003). Incision and drainage was performed, and tissue and fluid specimens were sent for a polymerase chain reaction (PCR) test for Mycobacterium tuberculosis complex DNA, which was positive. 1 week after the PCR results, the sample from the first aspiration confirmed the presence of alcohol- and acid- fast bacilli. This was after an extended culture period of 11 weeks.


Osteoarticular tuberculosis: The great mimicker still catches us out--a case report.

Magnussen A, Amirthanayagam T, Sofat R - Acta Orthop (2015)

MRI showed a multi-loculated collection at the distal humerus (upper panel) and the proximal radio-ulnar joint (lower panel). Key: A: ulna; B: radius; C: humerus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940598&req=5

Figure 0002: MRI showed a multi-loculated collection at the distal humerus (upper panel) and the proximal radio-ulnar joint (lower panel). Key: A: ulna; B: radius; C: humerus.
Mentions: Because of his swollen and inflamed elbow, he was now started empirically on intravenous flucloxacillin. When there was no response to this intervention, magnetic resonance imaging (MRI) of the elbow was performed and revealed a large, multi-loculated collection in continuity with the elbow joint and marked synovial proliferation with bony erosions (Figure 2). These radiological findings gave high suspicion of tuberculosis (Malavia and Kotwal 2003). Incision and drainage was performed, and tissue and fluid specimens were sent for a polymerase chain reaction (PCR) test for Mycobacterium tuberculosis complex DNA, which was positive. 1 week after the PCR results, the sample from the first aspiration confirmed the presence of alcohol- and acid- fast bacilli. This was after an extended culture period of 11 weeks.

View Article: PubMed Central - PubMed

Affiliation: a Department of Trauma and Orthopaedics , Lister Hospital , London , United Kingdom.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Given the demographics of the patient and the presenting symptoms, there was high clinical suspicion of tuberculosis, which we investigated accordingly... Routine blood tests and radiographs of the chest and elbow did not give a specific diagnosis (Figure 1)... Samples were sent for microscopy and culture, looking specifically for acid-fast bacilli... The final culture results were reported after 8 weeks and were negative... The elbow was painful but not swollen, and there was no indication for further investigation at this stage... As the elbow remained painful and swollen, but with no clinical evidence of intra-articular involvement, the patient was given the diagnosis olecranon bursitis and steroid injections were administered, initially with good response... However, a few months later he returned with worsening pain and reduced range of motion... Due to the previous (negative) culture results, tuberculosis was not suspected... Initial results did not reveal any organisms... As demonstrated by our case, delay in diagnosis of tuberculous arthritis can result in irreversible osteoarticular destruction... Despite our high suspicion of tuberculosis and appropriate first-line investigations, we were falsely reassured by the negative lavage and initially negative aspiration culture... The resulting delay in diagnosis and initiation of definitive treatment led to significant damage to the elbow... In that case, the patient presented with a 3-month history and underwent serial bursal debridements over the course of 4 years before the diagnosis of Mycobacterium tuberculosis was confirmed by extended culture for acid-fast bacilli.

Show MeSH