Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Infect Dev Ctries. 2024 Aug 31;18(8):1291-1295. doi: 10.3855/jidc.18303.
The most common anatomic sites affected by extrapulmonary tuberculosis are lymph nodes, pleura, bones, and joints, urogenital tract, and meninges. Tuberculous arthritis is difficult to diagnose early because of its atypical insidious clinical manifestations and non-specific imaging findings.
A 59-year-old male presented with progressive swelling in his left knee for over two months. The patient was initially misdiagnosed with pigmented villonodular synovitis (PVNS) and had undergone total knee arthroplasty (TKA) two years ago, however, the TKA did not completely alleviate his symptoms. Comprehensive radiological and laboratory assessments, including X-rays, magnetic resonance imaging and computed tomography scans, and an interferon-γ release assay (IGRA), pointed towards a diagnosis of tuberculous knee arthritis. Definitive diagnosis was established through the detection of Mycobacterium tuberculosis (MTB) DNA in the synovial fluid via polymerase chain reaction (PCR) and a positive IGRA result.
The case underscores the importance of considering MTB infection in the differential diagnosis of chronic unilateral knee arthritis, especially given the atypical clinical manifestations and imaging findings that can mimic other conditions like PVNS.
肺外结核最常累及的解剖部位是淋巴结、胸膜、骨骼和关节、泌尿生殖道和脑膜。结核性关节炎由于其非典型的隐匿性临床表现和非特异性影像学表现，早期诊断较为困难。
一名 59 岁男性，左膝关节进行性肿胀超过两个月。患者最初被误诊为色素沉着绒毛结节性滑膜炎（PVNS），并在两年前接受了全膝关节置换术（TKA），但 TKA 并未完全缓解其症状。综合影像学和实验室评估，包括 X 线、磁共振成像和计算机断层扫描，以及干扰素-γ释放试验（IGRA），提示结核性膝关节关节炎的诊断。通过聚合酶链反应（PCR）检测滑液中结核分枝杆菌（MTB）DNA 和 IGRA 阳性结果，明确了诊断。
本病例强调了在慢性单侧膝关节关节炎的鉴别诊断中考虑 MTB 感染的重要性，特别是在临床表现和影像学表现不典型，可能类似于 PVNS 等其他疾病的情况下。
