Rahman Asbah, Randhawa Aastha, Lin Yu Shia
Maimonides Medical Center, Brooklyn, NY, USA.
IDCases. 2024 Dec 17;39:e02134. doi: 10.1016/j.idcr.2024.e02134. eCollection 2025.
An 85-year-old woman with a history of total knee replacements for osteoarthritis in the past, presented with left knee swelling and pain that persisted for 14 months. An initial diagnosis of synovial cyst was made, and she underwent multiple aspirations and symptomatic treatments without improvement. Repeat arthrocentesis showed a WBC of 56,000/μL with 61 % neutrophils and 34 % lymphocytes. Synovial fluid bacterial and fungal cultures were negative. The acid-fast bacilli (AFB) culture revealed the Mycobacterium tuberculosis complex and was confirmed by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) Mass Spectrometry. This case highlights the challenges of diagnosing tuberculous prosthetic joint infection in an elderly individual with knee pain.
一名85岁女性，既往有因骨关节炎行全膝关节置换术史，出现左膝肿胀和疼痛，持续14个月。初步诊断为滑膜囊肿，她接受了多次穿刺抽吸和对症治疗，但病情无改善。重复关节穿刺显示白细胞计数为56,000/μL，中性粒细胞占61%，淋巴细胞占34%。滑液细菌和真菌培养均为阴性。抗酸杆菌（AFB）培养显示结核分枝杆菌复合群，经基质辅助激光解吸/电离飞行时间（MALDI-TOF）质谱法确认。该病例凸显了在一名有膝关节疼痛的老年个体中诊断结核性人工关节感染的挑战。
