Osteoarticular Tuberculosis: A Secondary Manifestations to Tuberculous Pleural Effusion

Main Article Content

Gurmeet Singh
Cleopas M Rumende
Bambang Setyohadi

Abstract

Tuberculosis appears to be increasing throughout the world after years of continuous decline, despite the introduction of effective chemotherapy. This resurgence is related to the increasing number of patients immunocompromised by chemotherapeutic agents used to treat other diseases or Acquired Immunodeficiency Syndrome (AIDS); the appearance of multiple drug-resistant strains of tuberculosis, and aging population. Musculoskeletal tuberculosis arises from haematogenous seeding of the bacilli soon after the initial pulmonary infection.1 Osteoarticular TB can occur in the knee - one study found of 1074 cases, 8.3 percent - or 90 cases - affected the knee.2 The clinical  symptoms are insidious onset, pain, swelling of the joint and limited range of movements. Investigations for suspected cases include: Mantoux test, radiological imaging, fine needle aspiration biopsy, surgical biopsy, bacteriological examination, histopathological examination, and polymerase chain reaction (PCR) of a suitable specimen. The mainstay of treatment is multidrug antitubercular chemotherapy. The main reason for poor outcome is delayed diagnosis.1 We report a case of osteoarticular manifestation of tuberculosis infection affecting the left knee presenting in a man with a history of tuberculosis pleural effusion. This case highlights, firstly, osteoarticular disease is always secondary to a primary lesion in the lung and, secondly, the diagnosis of tubercular arthritis can be challenging, particularly in the presence of confounding factors such as preexisting arthritis. Ethical approval was not required for this case study.

Article Details

How to Cite
Singh, G., Rumende, C., & Setyohadi, B. (2018). Osteoarticular Tuberculosis: A Secondary Manifestations to Tuberculous Pleural Effusion. Indonesian Journal of Rheumatology, 5(1). https://doi.org/10.37275/ijr.v5i1.50
Section
Case Report

References

1. Abdul H, Mousa L. Bones and Joints Tuberculosis. Bahrain Medical Bulletin, 2007; 29: 1-8.
2. Demni K. Tuberculosis of the Patella in Children - Case Report. Journal of rthopedics, 2007;3:23.
3. Lidder S, Lang K, Haroon M, Shahidi M, Guindi ME. Tuberculosis of the knee. Orthop Rev (Pavia), 2009;1:24.
4. Payne K, Yang J. Osteoarticular tuberculosis: a case report and discussion. CMAJ, 2002;5:628-30.
5. Mittal R, Trikha V, Rastogi S. Tuberculosis of patella. The Knee, 2006;13:54–6.
6. Adler AC. Tuberculosis: Old World treatment for New World disease. Clin Imaging, 2009;33:136.
7. Sharma SK, Mohan A. Extrapulmonary tuberculosis. Indian J Med Res, 2004;120: 316-53.
8. Mah ESL, Bux SI. Tuberculous synovitis of the knee with unusually thick synovial granulation tissue: A Case Report. The Internet Journal of Orthopedic Surgery ,2007;2: 1531-2968.
9. Vaughan KD. Extraspinal osteoarticular tuberculosis: A forgotten entity? West Indian Med J,2005;54:202–6.
10. Leclere LE, Sechriest VF, Holley KG. Tuberculous arthritis of the knee treated with two-stage total knee arthroplasty. A case report. J Bone Joint Surg (Am),2009;91:186–91