Tuberculous Arthritis

C. Tolis, MD

,
G. I. Goudevenos, MD

A 72-year-old woman was hospitalized after 8 years of pain and swelling of the right metatarsophalangeal joint. (In this film, the dark area over the distal joint of the large toe is an artifact.) Results of a purified protein derivative tuberculin test were positive, and a chest film revealed apical changes compatible with old tuberculosis (TB).

A 72-year-old woman was hospitalized after 8 years of pain and swelling of the right metatarsophalangeal joint. (In this film, the dark area over the distal joint of the large toe is an artifact.) Results of a purified protein derivative tuberculin test were positive, and a chest film revealed apical changes compatible with old tuberculosis (TB). The diagnosis of tuberculous arthritis was established following open synovial biopsy, which showed caseating granulomas and cultures positive for acid-fast bacilli.

Skeletal TB usually has a chronic course and, unfortunately, the diagnosis is seldom considered or made until bone destruction occurs and joint function is compromised. For this reason, skeletal TB needs to be included in the differential diagnosis of monarticular arthritis.