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Case Reports
. 2016 Jan-Mar;6(1):23-5.
doi: 10.13107/jocr.2250-0685.368.

Young Adult Hip: Reactivation of dormant, previously undiagnosed Mycobacterium Tuberculosis infection following intra-articular steroid injection

Tadros B J  1 , Stafford G H  1
Affiliations
Case Reports

Young Adult Hip: Reactivation of dormant, previously undiagnosed Mycobacterium Tuberculosis infection following intra-articular steroid injection

Tadros B J et al. J Orthop Case Rep. 2016 Jan-Mar.

Abstract

Introduction: Tuberculosis (TB) still remains a common problem in the UK and, with the increasing number of patients being offered arthroplasties; periprosthetic involvement is not uncommon anymore. However, the diagnosis of TB infected arthroplasties still remains difficult and misdiagnosis is common, therefore delaying treatment.

Case report: We describe a 36-years old Caucasian female with no known history of TB who presented with hip pain thought to be due to femoro-acetabular impingement (FAI). In the course of 18 months, the patient had been investigated extensively; including steroid injection, hip arthroscopy (including synovial biopsies), and eventually a total hip arthroplasty. During arthroplasty, further extensive biopsies were performed which raised the suspicion of TB on histology. Further synovial biopsies obtained arthroscopically were microbiologically positive for TB (PCR). The patient was sent to an infectious disease specialist. It appeared that the patient had TB in the past, of which she was unaware.

Conclusion: We hypothesise that the immunosuppressant effects of the steroid injections she received reactivated her TB.

Keywords: Arthroplasty; Mycobacterium Tuberculosis; Peri-prosthetic infection; Steroids.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Pre-operative X-ray shows avulsion fracture of the fibular head without dislocation of the knee joint.
Figure 2
Figure 2
Anteroposterior view of injured knee under varus stress shows opening of lateral joint line.
Figure 3
Figure 3
Magnetic resonance imaging section shows avulsion of the fibular head with soft-tissue edema around fibular neck.
Figure 4
Figure 4
Intraoperative photograph shows lacerated common peroneal nerve with retracted avulsed fibular head along with ligaments.
Figure 5
Figure 5
Post-operative X-ray showing fixation of avulsed fibular head.
See this image and copyright information in PMC

References

    1. Ryan W, Mahony N, Delaney M, O’Brien M, Murray P. Relationship of the common peroneal nerve and its branches to the head and neck of the fibula. Clin Anat. 2003;16(6):501–505. - PubMed
    1. Shevell MI, Stewart JD. Laceration of the common peroneal nerve by a skate blade. CMAJ. 1988;139(4):311–312. - PMC - PubMed
    1. Robertson A, Nutton RW, Keating JF. Dislocation of the knee. J Bone Joint Surg Br. 2006;88(6):706–711. - PubMed
    1. Huang GS, Yu JS, Munshi M, Chan WP, Lee CH, Chen CY, et al. Avulsion fracture of the head of the fibula (the “arcuate” sign):MR imaging findings predictive of injuries to the posterolateral ligaments and posterior cruciate ligament. AJR Am J Roentgenol. 2003;180(2):381–387. - PubMed
    1. Seebacher JR, Inglis AE, Marshall JL, Warren RF. The structure of the posterolateral aspect of the knee. J Bone Joint Surg Am. 1982;64(4):536–541. - PubMed

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