Coexistence of Miliary Tuberculosis with Tubercular Sacroiliitis in a Young Immunocompetent Female (original) (raw)
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Musculoskeletal Tuberculosis: A Multifaceted Foe
Annals of the National Academy of Medical Sciences (India)
Tuberculosis (TB) still remains a global epidemic, and India accounts for one-fourth of the world's TB burden. The incidence of extrapulmonary TB has relatively remained constant, but with the introduction of antitumor necrosis factor, there has been a surge in pulmonary and extrapulmonary TB cases presenting to rheumatologists. Musculoskeletal TB accounts for 10 to 30% of all cases of extrapulmonary TB, with spondylitis (Pott's spine) being the most common manifestation. Manifestations mimicking autoimmune spondylitis are seen in 10% of cases. Tubercular arthritis most commonly presents with large joint monoarthritis, but oligo- or polyarticular involvement is also seen. Poncet's disease is a form of reactive arthritis occurring in patients with pulmonary or extrapulmonary TB, which is rarely seen with good response to antitubercular treatment. Quite often, there is delay in the diagnosis of musculoskeletal TB due to absence of constitutional symptoms. Treatment of musc...
Cureus, 2023
While Mycobacterium tuberculosis is a common bacterial pathogen that infects the respiratory system, especially in endemic regions, it may uncommonly manifest in other organ systems, such as the nervous, gastrointestinal, or musculoskeletal systems. Sacroiliac joint infections are rare, and only 1%-5% of all infections are tuberculous in nature. Given nonspecific inflammatory signs in both laboratory and radiologic examinations, early identification of the causative agent can be difficult. In this report, we present the case of a 29-year-old Eritrean woman who presented with an uncommon extrapulmonary tuberculosis manifestation of the right sacroiliac joint. The patient reported pain for two years before a formal diagnosis with multiple computed tomography scans demonstrated fluid collections about her right hip and thigh. The patient's medical history of developmental delay, psychosis, outdated medication documentation, non-therapeutic use of numerous psychiatric medications contraindicated for traditional anti-tubercular therapy, and socioeconomic history of a lack of social support and treatment arrangements with the patient's caregiver all complicated the treatment course. Given the rise in tuberculosis cases worldwide and vulnerability factors in patients with mental illnesses such as poverty, homelessness, diabetes, and HIV infection that can predispose patients to tuberculosis infections, early diagnosis and treatment are essential to reduce long-term consequences and improve clinical outcomes. Further research in the development of new tuberculosis treatment plans is essential to addressing an equitable treatment course alongside fighting against the recent rise in drug-resistant tuberculosis.
OSTEOARTICULAR MANIFESTATIONS IN TUBERCULOSIS: A LITERATURE REVIEW (Atena Editora)
OSTEOARTICULAR MANIFESTATIONS IN TUBERCULOSIS: A LITERATURE REVIEW (Atena Editora), 2024
INTRODUCTION: Bone tuberculosis, also known as osteoarticular tuberculosis, is a clinical manifestation of extrapulmonary tuberculosis. This condition occurs when the bacteria Mycobacterium tuberculosis spreads through the lymphatic or blood system following a primary lung infection or reactivation of a latent infection. Symptoms may appear years or decades after the initial infection. It is important to highlight that extrapulmonary cases are rare and are often not considered in the differential diagnosis, especially when there are chronic musculoskeletal complaints. Signs and symptoms, as well as radiographic findings, are not specific, which results in delays in diagnosis of more than a year after the first symptoms. The osteoarticular manifestation of tuberculosis can lead to the disabling destruction of bone, cartilage and surrounding soft tissue, which can be worsened by delays in diagnosis. OBJECTIVES: The study aims to analyze the main osteoarticular manifestations in tuberculosis, as this is a serious condition that can appear long after the primary or latent infection, showing manifestations in the osteoarticular system. METHODOLOGY: The exploratory research method was used in this work, through a bibliographic search to obtain references that expand knowledge of osteoarticular manifestations in tuberculosis. The research was based on scientific articles published between 2010 and 2023, selected from scientific bases such as Pubmed and SciELO. For the search, health descriptors relevant to the topic were used, such as “Extrapulmonary tuberculosis”, “Mycobacterium tuberculosis”, “Infectious arthritis, “Miliary tuberculosis”, “Osteoarticular tuberculosis”. RESULTS AND DISCUSSION: The articles analyzed demonstrated that extrapulmonary manifestations of tuberculosis have been increasing and, in addition to this, in most cases, it presents non-specific signs and symptoms, delaying diagnosis. Delay in diagnostic suspicion contributes to the emergence of serious changes in the joints involved, such as pre-auricular fistulas, ulcers, salivary gland involvement, osteomyelitis, infectious arthritis and otitis. Vertebral tuberculosis stands out as the most common form of bone tuberculosis, resulting in the destruction of the vertebral bodies and deformities of the dorsal column, whether or not associated with pulmonary disease. The vertebrae are the most affected bones, known as "Pott's disease", followed by the epiphyses of the long bones and the joints of knee and hip are generally affected. Among the deformities found in the spine, scoliosis and kyphosis stand out. Progressive kyphosis occurs most frequently when the affected area comprises the lower thoracic spine and the thoracolumbar transition. Spinal cord involvement is most common in the cervical and upper thoracic regions. Involvement of the cervical spine is rare and is associated with a high mortality rate, while involvement of three or more vertebrae represents a high risk of paraplegia. CONCLUSION: The osteoarticular manifestations of tuberculosis affect any bone or joint, however it is more common in the spine, hips and knees. Early diagnosis and appropriate treatment are essential to prevent serious complications, such as permanent deformities and joint dysfunction. More research is needed to improve understanding of the pathophysiology, diagnosis and management of osteoarticular tuberculosis, seeking more advanced diagnostic strategies and new therapeutic approaches.
Arthritis associated with tuberculosis
Best Practice & Research Clinical Rheumatology, 2003
There has been a resurgence in tuberculosis (TB) worldwide. Approximately 2 billion people have latent infection, 8 million would develop active TB annually, and 2-3 million would die due to TB. With this resurgence, cases with extrapulmonary TB have also shown an increase. Approximately 10-11% of extrapulmonary TB involves joints and bones, which is approximately 1-3% of all TB cases. The global prevalence of latent joint and bone TB is approximately 19-38 million. TB arthritis most commonly manifests as a monoarthritis of weight-bearing joints in the hip or the knee. Oligo-or polyarticular presentation is not rare and may cause diagnostic confusion with inflammatory arthritis. Owing to the low incidence in developed countries, the diagnosis of joint and bone TB is often delayed. A high degree of sensitivity to this diagnosis would prevent delays, permitting prompt institution of anti-TB therapy and preventing irreversible joint damage. Despite advances, confirmation of diagnosis still relies on lengthy microbiological techniques or invasive biopsy. Due to the frequency of isoniazid resistance, initial treatment at present typically includes a combination of four drugs: isoniazid, rifampicin, pyrazinamide and streptomycin or ethambutol. Antimicrobial therapy should be of at least 9 months duration, longer in children and immunocompromised hosts. Surgical procedures should be restricted to joints with severe cartilage destruction, large abscesses, joint deformity, multiple drug resistance or atypical mycobacteria.
IP Innovative Publication Pvt. Ltd., 2018
Introduction and Objectives: Clinicians consider musculoskeletal tuberculosis as diagnostic dilemma because diagnosis frequently gets delayed due to its varied clinical presentation, false negative results on smear microscopy and less sensitivity on culture methods (20-40%). The main objectives were to know the prevalence of musculoskeletal tuberculosis (TB) among patients attending NEIGRIHMS and to understand clinical bacteriological profile of musculoskeletal tuberculosis using conventional and molecular laboratory diagnostic methods. Materials and Methods: In this study, a total of fifty two clinical specimens like pus swab, ultrasonography guided (USG) pus aspiration, synovial fluid and bone biopsy of newly suspected musculoskeletal tuberculosis patients were evaluated for microscopy, culture and molecular detection of M. tuberculosis. Results: The study reveals prevalence of 46.2% musculoskeletal tuberculosis among the clinically suspected patients. The most commonly involved sites in suspected musculoskeletal tuberculosis were hip joint (23.1%). USG guided pus comprises only 26.9% of the samples collected, however, yield of M. tuberculosis from them were 71%. PCR detected the maximum number of cases of musculoskeletal tuberculosis 24 (46.2%) followed by culture method 13 (25%) and smear microscopy 1 (1.92%). Conclusion: This observation will help guiding clinicians in effective management of musculoskeletal tuberculosis cases because delayed diagnosis and treatment in musculoskeletal TB results in poor outcome. Keywords: Extrapulmonary tuberculosis, Osteoarticular, Polymerase Chain reaction.
Case report on the recurrence of tuberculosis of hip after 40 years
SpringerPlus, 2014
Tuberculosis of joints is relatively rare condition and is associated with varied degree of immobility as well as other limitations. Tuberculosis of hip joint results in a remarkable decline in the living standard of the patients since hip joint has a wide range of function in daily movements apart from being the pivotal weight bearing joint in human body. The degeneration of hip joint culminates into long term morbidity for the patient. In this case report we present a patient who had suffered from the tuberculosis of hip joint 40 years before and had received the standard anti-tuberculosis chemotherapeutic regimen with isoniazid, rifampicin, pyrazinamide and ethambutol. After treatment, the patient had some degree of relief from the pain however the movement of the hip joint was restricted; the restriction increasing progressively since. On diagnostic testing he was found to have a recurrence of tuberculosis along with the old scar tissue left by the primary condition. The patient...
Tuberculosis presenting as arthritis of the ankle: A case report
SAGE Open Medical Case Reports, 2021
Tuberculosis presenting as monoarticular involvement in immunocompetent patients is rare. Here, we report a Sri Lankan patient presenting with ankle swelling due to tuberculosis with no other extrapulmonary or pulmonary involvement. Magnetic resonance imaging showed destruction of articular cartilage of the ankle joint with chronic inflammation of the subtalar joint. The diagnosis was confirmed by synovial tissue culture which was positive for Mycobacterium tuberculosis. The patient recovered uneventfully with anti-tuberculosis treatment. Therefore, a high degree of suspicion is necessary to diagnose extrapulmonary tuberculosis when patients are presenting with atypical monoarthritis.
A Case of Knee Monoarthritis Caused by Mycobacterium Tuberculosis
American Journal of Case Reports
Challenging differential diagnosis Background: Skeletal involvement is an uncommon form of extrapulmonary Mycobacterium tuberculosis (MTB) that occurs in 1-3% of the patients. Knee joints may be affected in 8% of cases. Case Report: We reported a case of TB knee arthritis in a 35-year-old Afghan male who was referred to Kashan Rheumatology Clinic for pain and swelling in the left knee. The patient had no history of fever, chills, weight loss, or anorexia. His chest radiography was normal. The synovial fluid culture was positive for M. tuberculosis. Magnetic resonance imaging (MRI) of the left knee demonstrated a marked joint effusion, chondromalacia in the lateral patellar facet, and edema in the origin of the gastrocnemius muscle. The histopathologic examination revealed multiple granulomas with foci of necrosis. Conclusions: This case demonstrated that clinicians should pay particular attention to the possibility of TB as the cause of chronic monoarthritis even when pulmonary involvement is not documented.
The Challenge of Tuberculosis Arthritis Differential Diagnosis
JCR: Journal of Clinical Rheumatology, 2019
T uberculosis (Tb) is an infectious disease that still represents a serious public health problem, causing a significant burden in health care worldwide, particularly in developing countries. One-third of world population has already been in contact with Tb, and approximately 2 million people die per year due to the infection. In Brazil, the incidence of pulmonary Tb remains high (34.8 cases per 100,000 inhabitants), especially in Amazonas (72.9 cases per 100,000 inhabitants), ranking first in Brazil with high mortality rate in 2018. 1 Although the lung is the primary site involved, bones and joints are affected in 1% to 3% of patients. 2 Bone and joint infection may account for approximately 14% of extrapulmonary Tb cases. 3 The spine is the most affected site, followed by the hips, knees, and small-sized joints. Signs and symptoms are generally nonspecific, and more than 50% of patients do not have concomitant lung disease. Acute Tb septic arthritis is usually monoarticular, and the organism is capable of being isolated. Synovial biopsy is the criterion standard for diagnosis, and it results positive in 80% of the cases. 2,4 Joint and bone infections are rheumatologic emergencies given their high morbidity and mortality. 5 The authors report 4 cases of Tb septic arthritis, whose diagnoses were difficult to make, thus warning physicians on the need for suspicion and early treatment, mainly in endemic areas, in order to contribute to better prognosis.