Right hip tuberculosis septic arthritis and osteomyelitis

Case contributed by RMH Core Conditions

Presentation

One week of lower back pain, right buttock pain. Unable to mobilise today.

Patient Data

Age: 35
Gender: Female

There is symmetric loss of right hip joint space with loss of definition of the subchondral bone plate of the acetabulum compared to the left hip. No fracture or subluxation detected. Alignment is unremarkable. 

A moderate sized joint effusion is demonstrated.

Loss of right femoroacetabular joint space with extensive low T1 signal within the acetabulum, the right femoral head, neck and intercondylar region with focal areas of osseous contrast enhancement within the acetabulum and there proximal femoral diaphysis.

Subchondral bony erosion.

Large multiloculated thickly rim enhancing joint effusion with multiple fluid locules noted. Direct involvement of the adjacent iliopsoas without extension superiorly into the pelvis or retroperitoneum.

Thickening and fluid is seen along the investing fascia of the quadriceps compartment of the thigh.

Conclusion:

Septic arthritis and osteomyelitis of the right hip joint with a multiloculated thickly enhancing joint effusion and adjacent extension into the right iliopsoas most consistent with tuberculous septic arthritis.

 

US-guided hip aspiration was performed.

MICROSCOPY Auramine-Rhodamine Stain: No Acid Fast Bacilli Detected A negative acid-fast smear result does not exclude the presence of Mycobacterium species.

ANTIGEN TESTING (ON ISOLATE) MPT64 Antigen Identification Test: M.tuberculosis Complex DETECTED 

NUCLEIC ACID TESTING (ON ISOLATE) Mycobacterium Sp. by DNA Probe: Positive for M.tuberculosis complex NUCLEIC ACID

MYCOBACTERIUM CULTURE SCREEN MGIT bottle <11 days POSITIVE 

MYCOBACTERIAL CULTURE

1. Mycobacterium tuberculosis ISOLATED. 

Case Discussion

Mycobacterium tuberculosis septic arthritis often affects and the knee or hip and usually results from reactivation of previous infection and can present without other symptoms of tuberculosis. Initial smears are often negative and synovial culture is positive in ~80% of cases 1

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Case information

rID: 28943
Case created: 23rd Apr 2014
Last edited: 14th Mar 2016
Inclusion in quiz mode: Included

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