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Extraspinal osteoarticular tuberculosis: A diagnostic and therapeutic challenge
Walid Bouaicha1, Saffet Nouicer2, Mohamed Jlidi1
1Department of Orthopedics and Traumatology, Mohamed Taher Maamouri Hospital, Nabeul; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
International Journal of Mycobacteriology
|December 27, 2023
Summary
Extraspinal osteoarticular tuberculosis (ESOTB) is a rare but serious condition. Early suspicion and diagnosis are crucial for effective treatment and patient recovery from this challenging bone and joint infection.
Area of Science:
- Infectious Diseases
- Orthopedics
- Radiology
Background:
- Tuberculosis (TB) poses a significant global health challenge, impacting morbidity and mortality.
- Extraspinal osteoarticular tuberculosis (ESOTB) is an uncommon manifestation of TB, presenting diagnostic difficulties.
Observation:
- A retrospective case series of five patients diagnosed with ESOTB between 2015 and 2022.
- Affected sites included the elbow, shoulder, greater trochanter, metatarsal, and distal interphalangeal joint.
- Common symptoms were pain, swelling, and limited range of motion, with a mean diagnostic delay of 5.8 months.
Findings:
- Diagnosis relied on bacteriological (culture, PCR) or histological analysis.
- Radiological findings included soft tissue swelling and bone destruction; histology was pathognomonic in 80% of cases.
- Polymerase chain reaction (PCR) was positive in both tested patients.
Implications:
- ESOTB requires a high index of suspicion in patients with persistent bone and joint symptoms.
- Prompt diagnosis and 9-12 months of oral TB treatment led to cure in all cases.
- While surgery was needed in one case for abscess drainage, conservative management with anti-TB therapy is generally effective.
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