Concomitant acromioclavicular and miliary tuberculosis

Area of Science:

• Orthopedics
• Infectious Diseases
• Radiology

Background:

• Miliary tuberculosis is a disseminated form of Mycobacterium tuberculosis infection.
• Extrapulmonary tuberculosis can present with varied and sometimes subtle symptoms.
• Acromioclavicular joint tuberculosis is a rare manifestation requiring prompt diagnosis and management.

Observation:

• A 48-year-old male patient with a 5-month history of unsuccessfully treated miliary tuberculosis presented with shoulder pain and swelling.
• Imaging revealed significant destruction of the acromioclavicular joint, indicative of a localized infectious process.
• Surgical intervention included distal clavicle excision, synovectomy, and abscess drainage.

Findings:

• Histopathology confirmed tuberculosis as the cause of acromioclavicular joint destruction.
• Post-operative recovery showed marked clinical, functional, and radiological improvement.
• The case suggests that treatment resistance in miliary tuberculosis may stem from occult extrapulmonary sites.

Implications:

• This case underscores the necessity of investigating extrapulmonary tuberculosis, particularly in cases of treatment-resistant miliary disease.
• Early surgical management of tuberculous arthritis can lead to favorable outcomes.
• Increased awareness of rare presentations of tuberculosis is crucial for effective patient care.