J Wrist Surg 2016; 05(01): 077-079
DOI: 10.1055/s-0035-1569484
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Acute Monoarthritis of the Wrist Joint: Tuberculosis or Not?

Prabha Desikan
1   Department of Microbiology, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India
,
Rahul Verma
2   Department of Orthopaedics, Gandhi Medical College and Associated Hospital, Bhopal, Madhya Pradesh, India
,
Karuna Tiwari
1   Department of Microbiology, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India
,
Nikita Panwalkar
1   Department of Microbiology, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India
› Author Affiliations
Further Information

Publication History

02 June 2015

15 July 2015

Publication Date:
15 December 2015 (online)

Abstract

Background Extrapulmonary tuberculosis (EPTB) is known to have many and varied presentations. However, isolated involvement of bone with tubercular infection is uncommon. The clinical features of such infections are known to mimic chronic pyogenic osteomyelitis, Brodie abscess, or tumors, but not acute monoarthritis.

Case Description We describe here an unusual case of tuberculous osteomyelitis that mimicked features of acute monoarthritis of the wrist joint.

Literature Review Extraspinal tuberculous osteomyelitis is rare and comprises only about 2 to 3% of all cases of osteoarticular tuberculosis, with the hip and knee joints being the most commonly involved. An extensive literature review did not show any published report of tuberculous osteomyelitis presenting as acute monoarthritis of the wrist joint.

Clinical Relevance This case underlines the importance of making EPTB an important differential diagnosis even in cases with clinical features that are completely inconsistent with tubercular infections.

 
  • References

  • 1 Wares F, Balasubramanian R, Mohan A, Sharma SK. Extrapulmonary tuberculosis: management and control. In: Agarwal SP, Chauhan LS, eds. Tuberculosis Control in India. New Delhi: Directorate General of Health Services, Ministry of Health & Family Welfare; 2005: 95-114
  • 2 Monir Madkour M ed. Tuberculosis. Berlin: Springer; 2004: 59-60
  • 3 Gardam M, Lim S. Mycobacterial osteomyelitis and arthritis. Infect Dis Clin North Am 2005; 19 (4) 819-830
  • 4 Burnwal R, Neogi DS, D. Ortho SS. Tubercular osteomyelitis of distal ulna presenting as epiphyseal injury. Maedica (Buchar) 2012; 7 (3) 247-250
  • 5 Chang DJ, Yoon DM, Kang YS, Yoon KB. Chronic back pain proven to be spinal tuberculosis: a report of 2 cases. Korean J Pain 2008; 21 (1) 74-79
  • 6 Akgün U, Erol B, Cimşit C, Karahan M. Tuberculosis of the knee joint: a case report [in Turkish]. Acta Orthop Traumatol Turc 2008; 42 (3) 214-218
  • 7 Rahman MS, Brar R, Konchwalla A, Sala MJ. Pain in the elbow: a rare presentation of skeletal tuberculosis. J Shoulder Elbow Surg 2008; 17 (1) e19-e21
  • 8 Chen WS, Wang CJ, Eng HL. Tuberculous arthritis of the elbow. Int Orthop 1997; 21 (6) 367-370
  • 9 Sasaki H, Inagaki M, Shioda M, Nagasaka K. Poncet's disease with high titers of rheumatoid factor and anti-citrullinated peptide antibodies mimicking rheumatoid arthritis. J Infect Chemother 2015; 21 (1) 65-69
  • 10 Arora VK, Chopra KK. Extra pulmonary tuberculosis. Indian J Tuberc 2007; 54 (4) 165-167