Tuberculosis of the knee: A pitfalls in clinical settings (A case report and literature review)

Abstract

Introduction: Tuberculosis of the knee is a rare form of diseases associated with tuberculosis that is frequently misdiagnosed as malignancy or bacterial infections. Its symptomatology might be identical to other conditions; thus finally turns the clinician misdiagnosed of the patient circumstances.

Presentation of the case: A 31-year-old male patient presented a unilateral knee swelling, reddish, warmth, pain, with a limited range of movement and then diagnosed with tuberculosis of the knee, histopathologically confirmed following surgical removal, including synovectomy without arthroplasty procedure. Furthermore, the patients underwent the administration of an anti-tuberculous drug regiment for a 1-year period. There was clinical improvement attained afterward after the prompt management since the initiation of therapy progressively.

Discussion: This case is unique due to the unspecific clinical manifestations of the disease, which contributed to delay diagnosis. Further, either the patients and his parents still had a lack of knowledge according to his condition. Opposite to the recent studies, there was an excellent outcome after simple surgical procedure, including synovectomy without arthroplasty followed by 1 year of anti-tuberculous drug.

Conclusion: Knee tuberculosis is a rare disease that often misdiagnosed as bacterial infections or malignancy. Mimicking clinical manifestations needs further surgical approach followed by histopathology examination to diagnose this disease. Early recognition and prompt treatment were crucially required to avoid the permanent limitation of movement that could affect the patient's quality of life. In this case, a lack of knowledge of the patient and his family significantly contributes to the delayed diagnosis.

Keywords: Knee; Rare case; Surgery; Tuberculosis.

Fig. 1

Knee Radiograph. (a) In 19 November 2013, it is shown the narrowing of knee joint gap. (b) In 18 January 2016, it can be observed that there has been a lytic lesion with ill-defined in periarticular projection in right proximal tibia and there was an ill-defined focal thickening in suprapatella and posterior of the right knee suspected a primer bone lesion in peri-articular proximal tibia

Fig. 2

MRI examination of the knee. (a) Based on coronal view, it showed well-defined iso-hyperintensed lesion and fat-set epimetaphysis femur (distal); tibia-fibula epimetaphysis (proximal); half of right inferior patella pole. (b) In sagittal T2 posterior projection of right genu, there was an iso-hyperintense mass that involved half of musculus gastrocnemius (mediolateral), plantaris, popliteal, and half of femoral arterial and venous and tibial nervesagittal view. (c) From the axial view, there was a free fluid collection in which dominant in suprapatella and minimal infrapatella projection.

Fig. 3

The macroscopic and microscopic appearance of tuberculosis of the knee. (a) The macroscopic examination showed the isolated of synovium destruction with cold abscess. (b) The microscopic examination revealed epitheloid proliferation, granuloma, necrotic, lymphocyte infiltration, and localized fibrosis, suspect of chronic specific inflammation including tuberculosis mass.

Fig. 4

In coronal and sagittal view showed the prominent lytic lesion in femur, tibia-fibula bone.