Tuberculosis of the Knee in a Child

Abstract

The diagnosis for skeletal tuberculosis is often overlooked. We report a 9-year-old patient with a history of 2 years of swollen joint, with a diagnosis of tuberculosis of the knee with involvement of the proximal tibial epiphysis, and treated surgically and with anti-tuberculosis drug therapy.

Tuberculous osteomyelitis of the long bones and joints

“…Skeletal tuberculosis may go underrecognized for months to years because of the indolent nature of the infection and the lack of specific signs or symptoms. 13,17 The adjacent joint may become involved as the bone is destroyed by pressure necrosis and cold abscess formation. Damage to the adjacent epiphyseal growth centers has been reported to occur in upto 41% of cases of bone disease in metaphyses are typically affected.…”

Concomitant cutaneous metastatic tuberculous abscesses and multifocal skeletal tuberculosis

“…The culture and PCR results were also negative for tuberculosis in our case. In endemic regions, the clinical features, radiological appearance and elevated ESR are sufficient to diagnose tuberculosis and begin treatment 10152324. Considering positive family history with a patient having cavernous tuberculosis in the same home environment, strong positive PPD results, X-ray findings and necrotising granulomas in histology, metastatic tuberculous abscesses and tuberculous osteomyelitis were diagnosed in our case.…”

Mycobacterium tuberculosis monoarthritis in a child

“…Tuberculous arthritis can result from direct invasion of Mycobacterium tuberculosis into a joint space (as in our case) or as a consequence of an aseptic reactive polyarthritis (Poncet's disease) [ 16 , 18 ]. Tuberculous arthritis associated with direct invasion is often monoarticular and characterized by an insidious onset [ 7 , 8 , 14 , 19 ] and not typically associated with signs of acute articular inflammation [ 13 ].…”

“…Rarely, intra-articular inflammation can occur in children either as a result of direct invasion of the tuberculous bacillus into the joint or as a consequence of an aseptic reactive arthritis (so-called Poncet's disease) related to an extra-articular tuberculous focus [ 3 - 20 ]. Intra-articular Mycobacterium tuberculosis infection is especially rare in children in the absence of associated pulmonary disease [ 7 , 8 , 13 , 14 , 17 , 19 ]. Consequently, delays in recognition and treatment of this diagnostically challenging condition occur.…”