Disseminated tuberculosis following total knee arthroplasty in an HIV patient.
Skeletal tuberculosis is now uncommon in developed countries. In immunocompromised patients--particularly in the HIV-infected--who present with subacute or chronic joint pain refractory to conventional treatment, osteoarticular tuberculosis should still be included in the differential diagnosis. We report on a lethal case of disseminated tuberculosis in an HIV-infected subject. Dissemination may have resulted from the implantation of an articular prosthesis in a knee joint with unsuspected osteoarticular tuberculosis. The diagnosis was established months later when the patient presented with far-advanced tuberculous meningitis, miliary tuberculosis of the lungs, femoral osteomyelitis and extended cold abscesses along the femoral shaft. Failure to respond to a conventional four-drug regimen is explained by the resistance pattern of his multi-drug resistant strain of Mycobacterium tuberculosis, which was only reported after the patient's death. This case illustrates the diagnostic challenges of osteoarticular tuberculosis and the consequences of a diagnostic delay in an HIV-infected individual.
Marschall
J
J
Division for Infectious Diseases, University Hospital Inselspital, Bern, Switzerland.
Evison
J-M
JM
Droz
S
S
Studer
U C
UC
Zimmerli
S
S
D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D017809:Fatal Outcome; D005269:Femur / Q000382:microbiology / Q000473:pathology; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D010019:Osteomyelitis / Q000209:etiology / Q000382:microbiology; D011859:Radiography; D014390:Tuberculosis, Meningeal / Q000209:etiology / Q000382:microbiology; D014391:Tuberculosis, Miliary / Q000209:etiology / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications* / Q000382:microbiology; D014394:Tuberculosis, Osteoarticular / Q000150:complications* / Q000382:microbiology / Q000601:surgery*; D014397:Tuberculosis, Pulmonary / Q000209:etiology / Q000382:microbiology