Disseminated tuberculosis following total knee arthroplasty in an HIV patient

J. Marschall, J. M. Evison, S. Droz, U. C. Studer, S. Zimmerli

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Skeletal tuberculosis is now uncommon in developed countries. In immunocompromised patients - particularly in the HIV-infected - who present with subacute or chronic joint pain refractory to conventional treatment, osteoarticular tuberculosis should still be included in the differential diagnosis. We report on a lethal case of disseminated tuberculosis in an HIV-infected subject. Dissemination may have resulted from the implantation of an articular prosthesis in a knee joint with unsuspected osteoarticular tuberculosis. The diagnosis was established months later when the patient presented with far-advanced tuberculous meningitis, miliary tuberculosis of the lungs, femoral osteomyelitis and extended cold abscesses along the femoral shaft. Failure to respond to a conventional four-drug regimen is explained by the resistance pattern of his multi-drug resistant strain of Mycobacterium tuberculosis, which was only reported after the patient's death. This case illustrates the diagnostic challenges of osteoarticular tuberculosis and the consequences of a diagnostic delay in an HIV-infected individual.

Original languageEnglish
Pages (from-to)274-278
Number of pages5
JournalInfection
Volume36
Issue number3
DOIs
StatePublished - Jun 2008

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