title: Multifocal skeletal tuberculosis in an immunocompetent patient: a case report.
abstract: BACKGROUND
  The occurrence of multifocal skeletal involvement in immunocompetent patients is rare, even in countries where tuberculosis is endemic. Multifocal skeletal lesions may occur as a result of hematogenous dissemination from another primary focus such as cervical lymph nodes, lungs, tonsils or gastrointestinal tract.
  
  
  METHODS
  We present a 59 year-old man with a history of intermittent and disabling pain in his left knee for 2 years. The patient in this case presented with lung infection with bilateral skeletal dissemination in the knees and femurs. Immunological examination for the HIV was negative.
  
  
  CONCLUSIONS
  Diagnosis of this condition is not always easy because of the disease's insidious character, and it can be confused with other diseases such as osteoarthritis, especially in middle-aged individuals.
authors.affiliation: Service of Infectious and Parasitic Diseases, Department of Tropical Medicine, Hospital de Clinicas, Federal University of Pernambuco, Cidade Universitária, Av. Prof. Moraes Rego, 1235, Recife, PE, CEP: 50.670-901, Brazil. psergio@cpqam.fiocruz.br.|Aggeu Magalhães Research Center, FIOCRUZ, Cidade Universitária, Av. Prof. Moraes Rego, 1235, Recife, PE, CEP: 50.670-901, Brazil. psergio@cpqam.fiocruz.br.
authors.forename: Paulo Sérgio Ramos
authors.initials: PS
authors.lastname: de Araujo
authors.affiliation: Service of Infectious and Parasitic Diseases, Department of Tropical Medicine, Hospital de Clinicas, Federal University of Pernambuco, Cidade Universitária, Av. Prof. Moraes Rego, 1235, Recife, PE, CEP: 50.670-901, Brazil. helramos@terra.com.br.
authors.forename: Heloisa Ramos Lacerda
authors.initials: HR
authors.lastname: de Melo
authors.affiliation: Aggeu Magalhães Research Center, FIOCRUZ, Cidade Universitária, Av. Prof. Moraes Rego, 1235, Recife, PE, CEP: 50.670-901, Brazil. fabio@cpqam.fiocruz.br.
authors.forename: Fábio Lopes
authors.initials: FL
authors.lastname: de Melo
authors.affiliation: Aggeu Magalhães Research Center, FIOCRUZ, Cidade Universitária, Av. Prof. Moraes Rego, 1235, Recife, PE, CEP: 50.670-901, Brazil. medeiros@cpqam.fiocruz.br.
authors.forename: Zulma
authors.initials: Z
authors.lastname: Medeiros
authors.affiliation: Service of Infectious and Parasitic Diseases, Department of Tropical Medicine, Hospital de Clinicas, Federal University of Pernambuco, Cidade Universitária, Av. Prof. Moraes Rego, 1235, Recife, PE, CEP: 50.670-901, Brazil. amaciel57@gmail.com.
authors.forename: Maria Amélia
authors.initials: MA
authors.lastname: Maciel
authors.affiliation: Service of Infectious and Parasitic Diseases, Department of Tropical Medicine, Hospital de Clinicas, Federal University of Pernambuco, Cidade Universitária, Av. Prof. Moraes Rego, 1235, Recife, PE, CEP: 50.670-901, Brazil. reps77@gmail.com.
authors.forename: Renata
authors.initials: R
authors.lastname: Florêncio
authors.affiliation: Aggeu Magalhães Research Center, FIOCRUZ, Cidade Universitária, Av. Prof. Moraes Rego, 1235, Recife, PE, CEP: 50.670-901, Brazil. brandaoe@cpqam.fiocruz.br.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Brandão
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001182:Arthroscopy / Q000009:adverse effects; D004269:DNA, Bacterial / Q000032:analysis; D005402:Fistula; D006801:Humans; D016867:Immunocompromised Host; D007717:Knee / Q000382:microbiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification; D010003:Osteoarthritis / Q000628:therapy; D010019:Osteomyelitis / Q000209:etiology / Q000382:microbiology; D016133:Polymerase Chain Reaction; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial