Unusual features of osteoarticular tuberculosis in children

Three children with tuberculous arthritis, two of whom also had tuberculous otitis media, are described. Two of the children were atypical at presentation, with an acute onset of arthritis, an elevated erythrocyte sedimentation rate, and a predominance of polymorphonuclear cells in the joint fluid. Both had histories of recurrent otitis media with perforations. Recognition that Mycobacterium tuberculosis could be the cause of disease in all three cases was delayed. Placement of a tuberculin skin test ultimately led to the correct diagnosis. These cases Illustrate that tuberculous arthritis is not always insidious in onset and underscore the need to maintain a high index of suspicion for tuberculosis infection in high-risk patient populations. Our experiences suggest that Mantoux skin tests might be considered part of the "routine" diagnostic study of children with arthritis or recurrent otitis media, especially in communities with high tuberculosis case rates.