Abstract
We present an atypical case of tuberculosis in an immunocompetent man from New Delhi, India. The patient entered the hospital with pain in left hip for two months. He had a history of joint pains involving both small and large joints for past two months, which was migratory in nature. There were no constitutional symptoms of fever, night sweats, weight loss or loss of appetite. Diagnosis of tuberculosis was made by full body FDG-PETCT Scan, followed by histopathology of the biopsy from the enlarged supraclavicular lymph node. Tuberculosis cases with such presentation are rather known with immunodeficient patients. Extrapulmonary tuberculosis, especially skeletal tuberculosis is seen more frequent in young immunocompetent patients. The migratory nature of the joint pains is rather unknown in cases of skeletal tuberculosis and needs more evaluation of such cases in the future.
References
- Malaviya AN, Kotwal PP (2003) Arthritis associated with tuberculosis. Best Pract Res ClinRheumatol 17: 319-343.
- Iademarco MF, Castro KG (2003) Epidemiology of tuberculosis. Semin Respir Infect 18: 225-240.
- Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR (2009) Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006. Clin Infect Dis 49: 1350-1357.
- Narang S (2012) Tuberculosis of the entheses. IntOrthop 36: 2373-2378.
- Mateo L, Ruiz Manzano J, Olivé A, Manterola JM, Pérez R, et al. (2007) [Ostearticular tuberculosis. Study of 53 cases]. Med Clin (Barc) 129: 506-509.
- Samuel S, Boopalan PR, Alexander M, Ismavel R, Varghese VD, et al. (2011) Tuberculosis of and around the ankle. J Foot Ankle Surg 50: 466-472.
- Harisinghani MG, McLoud TC, Shepard JA, Ko JP, Shroff MM, et al. (2000) Tuberculosis from head to toe. Radiographics 20: 449-470.
- Abdulaziz S, Almoallim H, Ibrahim A, Samannodi M, Shabrawishi M, et al. (2012) Poncet's disease (reactive arthritis associated with tuberculosis): retrospective case series and review of literature. Clin Rheumatol 31: 1521-1528.
- Abdelwahab IF, Bianchi S, Martinoli C, Klein M, Hermann G (2006) Atypical extraspinal musculoskeletal tuberculosis in immunocompetent patients: part II, tuberculous myositis, tuberculous bursitis, and tuberculoustenosynovites. Can AssocRadiol J: 278-286.
- Poncet A (1897) De la polyarthritestuberculeusedeformanteoupseudorheumatismechroniquetuberculeux. CongresFrancaise de chirurgerie 1: 732.
- Netval M, Hudec T, Hach J (2007) [Our experience with total knee arthroplasty following tuberculous arthritis (1980-2005)]. ActaChirOrthopTraumatolCech 74: 111-113.
- Sequeira W, Co H, Block JA (2000) Osteoarticular tuberculosis: current diagnosis and treatment. Am J Ther 7: 393-398.
- ChenskiĬ EP, Omirova KT, SuleĬmanovBSh (1980) [Characteristics of osteoarticular tuberculosis patient contingents in Kazakhstan and the ways for their detection]. ProblTuberk 6-8.
- Tuli SM (2002) General principles of osteoarticular tuberculosis. ClinOrthopRelat Res: 11-19.
- Leibe H, Köhler H, Kessler P (1982) [Osteoarticular tuberculosis. Review - current status of diagnosis and therapy]. ZentralblChir 107: 322-342.
- Magnussen A, Dinneen A, Ramesh P (2013) Osteoarticular tuberculosis: increasing incidence of a difficult clinical diagnosis. Br J Gen Pract 63: 385-386.
- Scanzello CR, Goldring SR (2012) The role of synovitis in osteoarthritis pathogenesis. Bone 51: 249-257.
- de Lange-Brokaar BJ, Ioan-Facsinay A, Yusuf E, Visser AW, Kroon HM, et al. (2013) Degree of synovitis on MRI by comprehensive whole knee semi-quantitative scoring method correlates with histologic and macroscopic features of synovial tissue inflammation in knee osteoarthritis. Osteoarthritis Cartilage
- Walker GF (1968) Failure of early recognition of skeletal tuberculosis. Br Med J 1: 682-683.
- Carli P, Landais C, Aletti M, Cournac JM, Poisnel E, et al. (2009) [Current treatment of rheumatoid arthritis]. Rev Med Interne 30: 1067-1079.
- Hsiao CH, Cheng A, Huang YT, Liao CH, Hsueh PR (2013) Clinical and pathological characteristics of mycobacterial tenosynovitis and arthritis. Infection 41: 457-464.
- Foocharoen C, Nanagara R, Foocharoen T, Mootsikapun P, Suwannaroj S, et al. (2010) Clinical features of tuberculous septic arthritis in KhonKaen, Thailand: a 10-year retrospective study. Southeast Asian J Trop Med Public Health 41: 1438-1446.
- Ellis ME, el-Ramahi KM, al-Dalaan AN (1993) Tuberculosis of peripheral joints: a dilemma in diagnosis. Tuber Lung Dis 74: 399-404.
- Tsuduki E, Kawada H, Takeda Y, Toyoda E, Kobayashi N, et al. (2002) [A case of multiple bone and joint tuberculosis which had been misdiagnosed as the rheumatoid arthritis and treated with prednisolone for eleven months]. Kekkaku 77: 361-366.
Corresponding Author
Himanshu Dhiman
Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi
DOI: https://dx.doi.org/10.18535/jmscr/v8i1.116
