Wang Ping-Huai, Shih Kao-Shang, Tsai Chien-Chen, Wang Hao-Chien
Division of Thoracic Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2007 Jan;106(1):82-5. doi: 10.1016/S0929-6646(09)60221-7.
Tuberculous prosthetic joint infection is rare. While early diagnosis is critical for treatment, it is usually delayed. Here, we present the case of a 72-year-old patient who underwent total knee arthroplasty for his right knee due to degenerative arthritis 4 years ago. Three years after arthroplasty, pulmonary tuberculosis was found and he hesitated on starting antituberculosis chemotherapy. He suffered from progressive pain and swelling of the right prosthetic knee for 2 months before this admission. The pathologic report of the debridement of the right prosthetic knee was caseous granulomatous inflammation with positive acid-fast staining bacilli. The culture of the debridement also yielded Mycobacterium tuberculosis. He died due to aspiration pneumonia with multiorgan dysfunction. This case is a reminder of the possibility of tuberculosis while dealing with prosthetic joint infection.
结核性人工关节感染较为罕见。虽然早期诊断对治疗至关重要，但通常会延迟。在此，我们报告一例72岁患者的病例，该患者4年前因退行性关节炎接受了右膝全膝关节置换术。关节置换术后三年，发现患有肺结核，他在开始抗结核化疗方面犹豫不决。入院前两个月，他的右人工膝关节出现进行性疼痛和肿胀。右人工膝关节清创术的病理报告为干酪样肉芽肿性炎症，抗酸染色杆菌呈阳性。清创术培养物也检出结核分枝杆菌。他因吸入性肺炎伴多器官功能障碍死亡。该病例提醒我们在处理人工关节感染时要考虑到结核的可能性。
