Musculoskeletal tuberculosis presenting as polyarthritis: a diagnostic challenge.

Area of Science:

• Rheumatology
• Infectious Diseases
• Geriatrics

Background:

• Polyarthritis in the elderly has diverse causes, including rheumatic diseases, infections, and malignancy.
• Distinguishing between these causes can be challenging, particularly in atypical presentations.

Purpose of the Study:

• To highlight the importance of considering tuberculosis as a differential diagnosis in elderly patients with polyarthritis.
• To emphasize the need for early recognition and prompt treatment of musculoskeletal tuberculosis.

Main Methods:

• A case report of a 72-year-old woman with a 2-year history of polyarthralgias.
• Diagnostic workup included laboratory tests, radiography, musculoskeletal ultrasound, and MRI.
• Confirmation of Mycobacterium tuberculosis infection via lymph node biopsy.

Main Results:

• The patient presented with seronegative polyarthritis, initially unresponsive to corticosteroids.
• Delayed diagnosis occurred despite negative initial tuberculosis screening.
• Anti-tuberculous therapy led to clinical improvement and resolution of cutaneous lesions.

Conclusions:

• Musculoskeletal tuberculosis is a rare but critical differential diagnosis in elderly patients with polyarthritis.
• Tuberculosis can mimic inflammatory rheumatic diseases, especially in seronegative cases, leading to diagnostic delays.
• Prompt diagnosis and treatment are vital to prevent irreversible joint damage and functional loss.