Tuberculosis of knee joint

Case contributed by Dr Shailaja Muniraj

Presentation

Loss of weight and low grade fever since 2 months. Unable to walk. Severe right knee pain.

Patient Data

Age: 75 years
Gender: Male
CT

There are ill-defined peripheral erosions of the lateral tibial plateau and intertibial region.

Juxta-articular osteopenia is seen.

Reduction in the femorotibial joint space. 

These features are consistent with Phemister triad of tubercular arthropathy.

MRI

Gross reduction of the medial and lateral compartments of femoro-tibial joint space with lateral subluxation of tibia seen.

Furthermore, there is significant synovial hypertrophy with moderate volume joint effusion.

Ill-defined erosions with destruction of the lateral tibial plateau and intertibial region. Minimal peri-lesional marrow edema noted. Similar such changes also noted in the fibular head.

Mild degenerative osteoarthritis with degenerative focal edema in the posterior horn of medial and lateral menisci noted.

The body of lateral meniscus shows a complete tear. Anterior cruciate ligament shows low-grade strain.

Special thanks: Dr. Nanda Kumar

Case Discussion

In a tuberculous endemic region, when patient presents with low grade fever / significant weight loss and imaging findings shows Phemister triad coupled with synovial hypertrophy and joint effusion, the possibility of tuberculous arthropathy must be assessed.  

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