Knee and the farm animals: An unusual presentation of Brucella melitensis masquerading as tuberculosis

Area of Science:

• Infectious Diseases
• Orthopedics
• Medical Diagnostics

Background:

• Brucellosis remains a significant clinical and diagnostic challenge in agrarian countries like India, despite eradication in developed nations.
• The disease presents with diverse clinical manifestations, often mimicking other conditions.
• Accurate and timely diagnosis is crucial for effective patient management and preventing complications.

Observation:

• A rare case of brucellosis presenting as septic arthritis of the knee joint with a lytic lesion in the proximal tibia is described.
• The patient exhibited chronic reactive knee arthritis symptoms, including synovial hypertrophy and effusion.
• The patient was from a Brucella-endemic region, raising suspicion for the disease.

Findings:

• Advanced diagnostic techniques were instrumental in differentiating brucellosis from tuberculosis.
• The diagnosis of tuberculosis was excluded, preventing the administration of empirical anti-tubercular therapy.
• Focused anti-Brucella management was initiated based on definitive diagnosis.

Implications:

• This case highlights the importance of considering brucellosis in the differential diagnosis of joint infections, especially in endemic areas.
• The successful diagnosis and targeted treatment underscore the value of advanced diagnostics in antimicrobial stewardship.
• Effective management of brucellosis can prevent long-term joint damage and systemic complications.