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|Year : 1995 | Volume
| Issue : 4 | Page : 110-1
Tuberculous arthritis of the knee--an unusual presentation.
S Chhabra, A Garde, H Singh
Department of Orthopaedics, KEM Hospital, Parel, Mumbai.,
Department of Orthopaedics, KEM Hospital, Parel, Mumbai.
A 54 year old male who had an unusual clinical manifestation and radiological features proven to have tuberculosis arthritis of the knee on synovial biopsy is presented here.
Keywords: Case Report, Diagnosis, Differential, Human, Knee Joint, radiography,Male, Middle Age, Tuberculosis, Osteoarticular, diagnosis,radiography,
|How to cite this article:|
Chhabra S, Garde A, Singh H. Tuberculous arthritis of the knee--an unusual presentation. J Postgrad Med 1995;41:110
The usual presentation of tuberculosis of the knee is a painful swollen knee which may be in the stage of synovitis or arthritis,. In addition the patient may have a deformity and a restricted range of movement. This case is presented for its unusual clinical manifestations and radiological features.
Mr. R. T. a 54 year old clerk complained of gradual onset of swelling and instability of the right knee of twelve years duration. There was no history of swelling in any other joint, trauma or fever, anorexia, weight loss or a history of pulmonary tuberculosis.
On examination, the right knee was warm with minimal joint line tenderness. Synovial thickening was present. Varus and valgus stress tests were positive. Anterior drawer test and pivot shift test were also positive. The patient had flexion deformity of 20 degrees with further flexion upto 110 degrees which was painless. There was no lymph node enlargement. Superficial sensations and joint and position sense were normal. Rest of the joints were normal.
Plain X-rays of the knee [Figure - 1] & [Figure - 2] revealed a marked reduction in joint space with multiple cysts in the tibia especially at the joint margins. After clinical and radiological assessment, a differential diagnosis of neuropathic arthritis, rheumatoid arthritis, tuberculosis and pigmented villonodular synovitis were considered. The radiological picture was similar to that of gout.
The hematological investigations done were: Hb: 12 gms %, total count: 5800/cmm, with a differential count of polymorphs: 72% and lymphocytes: 28%. ESR: 50 mm one hour. FBS: 89 mg %, PLBS: 100 mg %. RA test was negative. Sr. uric acid: 4.7 mg %. BUN: 12 mg %. A synovial biopsy was done which showed many epithelioid granulomas with foci of necrosis. Hence, a diagnosis of tuberculosis was made.
Tuberculosis of the knee may present as a low grade chronic granulomatous lesion which may persist with grumbling activity for a long period. A painless range of movement with instability which simulates a neuropathic arthritis is very uncommon. Such a case has not been reported in literature. Two cases of tuberculosis with neuropathic presentation - one affecting the elbow and one affecting the spine have been studied by Mehta S. D. Thus we hypothesise that sometimes the Mycobacterium tuberculosis may simulate Mycobacterium leprae ce a neuropathic arthritis.
| :: References|| |
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|2.||Tuli SM. Sinha GR Skeletal Koch's - unusual lesions. Ind J Orthop 1969; 3:5-18. |
|3.||Su JY Lin. SY Liao JS. Tuberculous arthritis of the knee J West Pacific Orthop Assoc. 1985; 22:11-6.
[Figure - 1], [Figure - 2]
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