Koch's Tuberculosis of the Sternoclavicular Joint

Tuberculosis bacilli have lived in symbiosis with mankind since time memorial. Rigveda and Atharvaveda (3500-188 B.C), Samhita of charka and Sushruta (1000 and 600 B.C) have mentioned the disease by the name of "Yakshma" in all forms. Lesions have been found in Egyptian mummies also. In western world, the clinical features and communicability of the disease were known before 1000 B.C. Tuberculosis is still a challenging health problem in developing countries, affecting almost all organs. Osteo articular tuberculosis is uncommon. Tuberculosis involving the sternoclavicular joint is extremely rare and often is misdiagnosed because of its rarity and unusual location. Literature has very less number of cases reported so far.

We are hereby reporting the case of a 70-year-old male, carpenter by profession who presented with right sternoclavicular joint swelling. Magnetic resonance imaging showed synovial thickening, articular, and subarticular erosions with diffuse sub chondral edema. Diagnosis was confirmed by ZN staining, FNAC, and diagnostic biopsy. Patient was managed conservatively by anti-tubercular treatment. Follow-up showed no relapse and improved clinical symptoms.

Earlier detection and management of tuberculosis of such rare variants of joint infection help in preventing the destruction of osteo ligamentous structures, abscess formation, and joint instability. The report emphasizes on the appropriate diagnosis and management.