Knee tuberculosis: A misleading clinical entity (case report)

Zendeoui, Ahmed; Oueslati, Achraf; Ahmed, Tounsi; Saadi, Saber; Znagui, Talel; Nouisri, Lotfi

doi:10.1016/j.ijscr.2022.107236

Cited by 5 publications

(16 citation statements)

References 12 publications

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“…Notably, even in the absence of tuberculosis lesions on pulmonary CT, the possibility of having tuberculosis cannot be de nitively excluded. Occasionally, tuberculosis lesions may be subtle or inconspicuous on CT images [12]. A negative culture for Mycobacterium tuberculosis does not completely rule out the possibility of tuberculosis [13].…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis infection of the ischium in a patient with poorly controlled diabetes mellitus: A case report

Huang,

Liu,

Ling

et al. 2024

Preprint

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Primary tuberculosis infection of the ischium is rare and challenging, particularly in immunocompromised patients. We present the case of a 74-year-old man with poorly controlled diabetes mellitus who developed persistent pain and swelling, even the sinus discharged from the left gluteal fold region. Imaging studies revealed lytic lesions in the ischium, cortical destruction, and soft tissue involvement. Histopathological examination confirmed that caseous necrosis occurred. The patient was initiated appropriate treatment for tuberculosis infection, and his symptoms improved without disease progression. Primary tuberculosis infection poses significant diagnostic challenges due to overlapping clinical and radiological features. Early recognition and a multidisciplinary approach involving infectious disease specialists, pulmonologists, radiologists, and surgeons are crucial for optimal management. The prognosis of this infection is poor, emphasizing the importance of timely diagnosis and treatment. To improve outcomes, comprehensive screening and early detection of infections in high-risk patients, such as those with uncontrolled diabetes, are essential. Future advancements in diagnostic tools may facilitate prompt and accurate diagnosis. Clinicians should maintain a high index of suspicion and employ appropriate diagnostic techniques to ensure early identification and effective management of these complex infections.

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Section: Discussionmentioning

confidence: 99%

Tuberculosis infection of the ischium in a patient with poorly controlled diabetes mellitus: A case report

Huang,

Liu,

Ling

et al. 2024

Preprint

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“…The main debated questions concern the duration of medical treatment as well as the need and modalities of any surgical treatment. Some authors 32 , 33 advocated for primary medical treatment with a combination of antituberculous antibiotics. The choice of drugs is generally the same as for pulmonary tuberculosis (isoniazid, rifampicin, pyrazinamide, and ethambutol).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Tuberculous abscess of the popliteal fossa: A case report

Belhassen,

Khlif,

Ferjani

et al. 2023

F1000Res

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Introduction Tuberculosis of the soft tissues is a rare form of extra pulmonary tuberculosis, and isolated localization in the popliteal fossa is particularly exceptional. Atypical clinical presentation can lead to delayed diagnosis and serious complications. Case report We report the case of a 17-year-old patient who was diagnosed with tuberculosis of the popliteal fossa. He presented with a painful inflammatory swelling of the right popliteal fossa associated with a homolateral inguinal lymph node, without knee joint effusion. Standard chest and knee X-rays were normal, while MRI showed an 8 cm well vascularized, partly liquefied mass in the popliteal fossa, developed in contact with the semimembranosus and medial gastrocnemius muscles, associated with a popliteal lymph node without synovial effusion or thickening. Microbiological tests did not isolate any germs. The diagnosis was made on histological examination after biopsy, which revealed a caseous granuloma surrounded by epithelioid cells. The patient was treated with anti-tuberculosis therapy for 9 months. The clinical and radiological regression of the swelling was observed without recurrence at 2 years of follow-up. Conclusion Any soft tissue abscess should raise suspicion of tuberculosis, especially in endemic countries. The importance of histopathological examination should be emphasized to establish the diagnosis in the absence of signs in favor of a primary localization.

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“…Diagnosing such cases is challenging primarily because clinical and radiological characteristics lack specificity, constitutional symptoms of TB are frequently absent, primary care physicians may lack awareness and training, leading to delayed diagnosis, and the disease itself tends to have a low bacterial burden [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Typically, tests such as chest X-ray, the Mantoux test, and the interferon gamma-release assay offer a reasonably high level of sensitivity, which can be valuable for clinicians [ 10 ]. However, the gold standard for initiating treatment remains the isolation of AFB through Ziehl and Neelsen stain microscopy and bacteria culture [ 10 ]. Nevertheless, the challenge arises when there is an absence of Mycobacterium tuberculosis growth in culture, coupled with the paucibacillary nature of the disease, leading to potential misdiagnosis or a diagnostic delay [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Primary Rifampicin Mono-Resistant Extrapulmonary Tuberculosis of the Knee Without Pulmonary Involvement: One of the First Cases of Its Type in an Immunocompetent Male

Yadav

2023

Cureus

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Tuberculosis presentation at sites other than the lungs is relatively infrequent, and isolated knee involvement without a pulmonary focus is exceptionally rare. Furthermore, there have been no reported cases of primary rifampicin mono-resistant extrapulmonary tuberculosis of the knee in males. In this case, a 24-year-old male patient presented with pain and swelling in his left knee after a fall five years ago. Given the absence of a history of tuberculosis, arriving at a diagnosis posed a significant challenge. However, the diagnosis was ultimately established through cartridge-based nucleic acid amplification tests and clinical link-up with radiometric techniques. Management was based on the latest national guidelines for anti-tuberculous treatment, which were tailored to his weight. To date, he has completed nine months of treatment with a significant improvement in his symptoms. This rare presentation emphasizes the need for a high degree of suspicion even in extrapulmonary tuberculosis cases.

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Knee tuberculosis: A misleading clinical entity (case report)

Cited by 5 publications

References 12 publications

Tuberculosis infection of the ischium in a patient with poorly controlled diabetes mellitus: A case report

Tuberculosis infection of the ischium in a patient with poorly controlled diabetes mellitus: A case report

Case Report: Tuberculous abscess of the popliteal fossa: A case report

Primary Rifampicin Mono-Resistant Extrapulmonary Tuberculosis of the Knee Without Pulmonary Involvement: One of the First Cases of Its Type in an Immunocompetent Male

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