CASE 652 Published on 22.10.2000

Tuberculous arthritis of the knee

Section

Musculoskeletal system

Case Type

Clinical Cases

Authors

E. Ooms, A. De Schepper, W. Simoens

Patient

30 years, male

Categories
No Area of Interest ; Imaging Technique MR, MR, MR
Clinical History
Conventional radiography and MRI revealed signs of arthritis. Examination of the synovial fluid marks the presence of Mycobacterium Tuberculosis. The tuberculine test was positive.
Imaging Findings
Clinical examination showed pain and swelling of the left knee, with impaired mobility of the joint. Conventional radiography revealed periarticular osteoporosis, osseous erosions, joint effusion and soft tissue swelling. Because of the suspicion of septic arthritis, aspiration and examination of the synovial fluid was done. Initially, no organisms were found on examina-tion of the synovial fluid. An MRI was performed which showed signs of synovitis, with hydrops of the joint (Fig 1,axial T2-WI).At a lower level thickened synovium and intra-articular effusion presented with a much lower signal intensity (Fig 2, axial T2-WI). There is a large erosive lesion at the anterior aspect of the femur with presence of slightly enlarged lymph nodes in the popliteal fossa (Fig 3, sagittal T1-WI). Luxation of the remnants of a partially destructed meniscus (Fig 4, coronal T1-WI) and areas of increased signal intensity within the cortical and medullary bone, suggestive for osteomyelitis (Fig 5 and 6, sagittal T2-WI), are also noted. Several additional punctures were performed, and finally the presence of Mycobacteri-um Tuberculosis was confirmed. Synovial biopsies obtained from the knee showed granulomatous disease consistent with tuberculosis. Radio-graphy and CT scan of the thorax revealed a state of active lung tuberculosis. The tuberculine test was positive.
Discussion
Tuberculosis has become a rare disease, especially in causing septic arthritis. In most cases, the infection is monoarticular, but polyarticular localisation is also possible. The hip, knee and spine are most frequently affected. Immunosuppression (AIDS), corticosteroid therapy, trauma or alcohol abuse are well known predisposing factors. The diagnosis is difficult to obtain because the disease is rare, the radiographic signs are difficult to differentiate from other types of septic arthritis and the difficulty of growing Mycobacterium Tuberculo-sis. In the differential diagnosis, following diseases must be included : pigmented villonodular synovitis, idiopathic synovial osteochondromatosis, juvenile chronic arthritis, rheumatoid arthritis, gout, pyrophosphate arthropathy, seronegative spondylarthropathy, chondrolysis, chondral atrophy, osteoarthritis and haemofilia.
Differential Diagnosis List
Tuberculous arthritis is an uncommon form of infectious arthritis. Immunosuppression, corticosteroid therapy, trauma or alcohol abuse make patients more susceptible to tuberculous arthritis. A possible strategy to detect tuberculous arthritis is : first,
Final Diagnosis
Tuberculous arthritis is an uncommon form of infectious arthritis. Immunosuppression, corticosteroid therapy, trauma or alcohol abuse make patients more susceptible to tuberculous arthritis. A possible strategy to detect tuberculous arthritis is : first,
Case information
URL: https://eurorad.org/case/652
DOI: 10.1594/EURORAD/CASE.652
ISSN: 1563-4086