Delayed diagnosis of extrapulmonary tuberculosis in a 32-year-old man with knee pain

Abstract

A 32-year-old Bangladeshi male was admitted at our emergency department for trauma of the left knee. The radiographs showed absence of fracture, and presence of an indeterminate oval lucency in the proximal tibia. Further examinations were suggested, but the patient refused. 6 months later, the patient re-presented at our emergency department. A CT scan showed progression of musculoskeletal involvement and spread to the liver. This case underlines the importance of considering tuberculosis in the differential diagnosis of indeterminate bone lesions in immigrant patients.

Figure 1.

(a, b) Radiographs of the left knee show a well-defined oval lucency in the medulla of the proximal tibial metaphysis (arrows). (c, d) On radiographs of the left tibia obtained 6 months later, the lesion appeared larger, ill-defined and predominantly sclerotic. Also note a small internal lytic area and a smooth periosteal reaction along the medial tibia cortex.

Figure 2.

CT scan shows a lytic lesion in the right iliac bone (arrow) in contiguity with a large abscess in the superficial tissue of the posterolateral right abdominal wall (asterisk).

Figure 3.

CT scan shows a lytic lesion of the left L1 pedicle (arrow).

Figure 4.

Contrast-enhanced CT scan shows a hypoattenuating, non-enhancing nodule in the liver, compatible with macronodular hepatic tuberculosis (arrow).