Tuberculous arthritis. Report of a case with multiple joint involvement and periarticular tuberculous abscesses

We describe a 41-year-old man with an unusual presentation of tuberculous joint disease involving 3 peripheral joints: right knee, wrist and first metatarsophalangeal. Periarticular "cold" tuberculous abscesses were observed in the ulnar aspect of his right hand and on the lateral aspect of his first right metatarsal bone. Mycobacterium tuberculosis was isolated from his knee and both abscesses. Synovial biopsies taken from these 3 joints showed typical tuberculous granulomata. M. tuberculosis was also isolated from 3 urine samples. Neither immunodeficiency, or a predisposing condition for tuberculosis could be demonstrated. Combined surgical and antibiotic treatment was effective.