title: Specific synovitis of a knee as the first manifestation of miliary tuberculosis.
abstract: Tuberculosis (TB) is declared global emergency. Miliary TB is a treatable, potentially lethal form of TB resulting from massive lympho-hematogenous dissemination of Mycobacterium tuberculosis. Impaired cell-mediated immunity underlies the disease's development. We present a case of specific synovitis in a 21-year-old Caucasian HIV-seronegative woman. She presented with high fever and swelling of the right knee. Chest radiograph revealed bilateral nodular opacities in upper pulmonary lobes and signs of pleural effusions. Sputum samples were negative for Acid Fast Bacilli (AFB) and Löwenstein-Jensen (L-J) culture negative. Diagnosis was confirmed histologically by pleural biopsy and positive L-J cultures of knee puncture, also documented by MRI. Treatment outcome was successful with anti-tuberculous drugs following standardized treatment regimen.
authors.affiliation: Clinical Centre of Serbia, Institute of Lung Diseases and Tuberculosis, Research and Epidemiology Department, Belgrade, Serbia.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Adzic
authors.forename: Dragica
authors.initials: D
authors.lastname: Pesu
authors.forename: Jelena
authors.initials: J
authors.lastname: Stojsic
authors.forename: Ljudmila
authors.initials: L
authors.lastname: Nagorni-Obradovi
authors.forename: Ruza
authors.initials: R
authors.lastname: Stevi
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D007719:Knee Joint / Q000382:microbiology*; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011718:Pyrazinamide / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use; D013585:Synovitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D016896:Treatment Outcome; D014391:Tuberculosis, Miliary / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D014394:Tuberculosis, Osteoarticular / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin