Disseminated Tuberculosis Following Total Knee Arthroplasty in an HIV Patient

Marschall, J; Evison, J-M; Droz, S; Studer, U C; Zimmerli, S (2008). Disseminated Tuberculosis Following Total Knee Arthroplasty in an HIV Patient. Infection, 36(3), pp. 274-278. Heidelberg: Urban & Vogel 10.1007/s15010-007-7011-1

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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.

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