Skeletal tuberculosis. Two case reports with a delay in diagnosis.

Area of Science:

• Orthopedics
• Infectious Diseases
• Rheumatology

Background:

• Osteoarticular tuberculosis is a significant cause of joint morbidity.
• Tuberculosis can present with atypical symptoms, complicating diagnosis.
• Standard microbiological cultures may not always detect Mycobacterium tuberculosis.

Observation:

• A case of Mycobacterium tuberculosis in the olecranon presented as septic bursitis.
• A childhood knee osteitis case, treated for trauma, experienced tuberculosis reactivation.
• Both patients showed negative cultures on standard media during initial symptom presentation.

Findings:

• Mycobacterium tuberculosis can mimic common orthopedic conditions like bursitis and trauma-induced osteitis.
• Delayed diagnosis of osteoarticular tuberculosis can lead to irreversible joint damage.
• Negative initial cultures do not rule out tuberculous joint infections.

Implications:

• Clinicians should maintain a high index of suspicion for tuberculosis in joint infections, especially with atypical presentations.
• Further diagnostic modalities may be necessary when initial cultures are negative.
• Understanding these presentations is key to timely and effective treatment of joint tuberculosis.