Case Report


Tuberculosis monoarthritis of the knee: A pediatric case report

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1 Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal

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Pedro Miguel Xavier Fernandes

Hospital São Francisco Xavier, Estrada Forte do Alto Duque, 1449-005 Lisboa,

Portugal

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Article ID: 100017Z14PF2019

doi: 10.5348/100017Z14PF2019CR

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How to cite this article

Fernandes PMX, Teixeira RFC, Rodeia JACF, Ribeiro HFM, da Silva JLUF, Coelho CAM. Tuberculosis monoarthritis of the knee: A pediatric case report. J Case Rep Images Orthop Rheum 2019;4:100017Z14PF2019.

ABSTRACT


Introduction: The overall incidence of acute septic arthritis is estimated to be 4–10 per 100,000 children in well-resourced countries. Staphylococcus aureus and respiratory pathogens are the most common causative agents. Only 3% of global tuberculosis (TB) cases were identified in the European region and 3% in the region of Americas. Bone and joint infection represent just 9% of extrapulmonary TB affection and, overall, for almost 2% of all cases.

Case Report: We present a case of a 15-year-old boy, born in Guinea Bissau, living in Portugal for nine months, who presented to the Emergency Department, with clinical and laboratory signs of acute knee arthritis. After proper surgical arthroscopic intervention and antibiotic therapy, he was discharged, asymptomatic. One week later, he was readmitted with a relapsed knee arthritis, without other positive clinical findings. At day 7 after intervention, there were imagiological signs of femoral osteomyelitis and although proper surgical and pharmacological intervention, there was no favorable evolution of clinical inflammatory signs. It was decided to perform an arthrotomy and curettage, demanding broader culture test with atypical microorganism studies and mycobacterium TB screening. Despite negative microbiological identification of mycobacterium, there was a positive Interferon Gamma Release Assay test, which forced us to test for intra-articular mycobacterium TB DNA through polymerase chain reaction (PCR), which was positive, and made it possible to apply an anti-TB regimen with four agents.

Conclusion: Although rare in developed countries, monoarthritis TB is difficult to diagnose and treat, demanding a high clinical index of suspicion, crucial to timely and accurately diagnose and treat this condition.

Keywords: Knee arthritis, Mycobacterium tuberculosis, Pediatric

SUPPORTING INFORMATION


Author Contributions

Pedro Miguel Xavier Fernandes - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Raquel Filipa Corda Teixeira - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Joaquim Augusto Carapeto Figueira Rodeia - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Hugo Filipe Marques Ribeiro - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

João Luís Umbelino Ferreira da Silva - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Final approval of the version to be published

Carla Alexandra Madail Coelho - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Guarantor of Submission

The corresponding author is the guarantor of submission.

Source of Support

None

Consent Statement

Written informed consent was obtained from the patient for publication of this article.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Conflict of Interest

Authors declare no conflict of interest.

Copyright

© 2019 Pedro Miguel Xavier Fernandes et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.


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