Multifocal osteoarticular tuberculosis and pleuropulmonary involvement in an immunocompetent patient

Introduction

Multifocal tuberculosis is an uncommon presentation in immune-competent patients; it’s associated more with an immune-depression like HIV (Human Immunodeficiency Virus) infection. Here, we are presenting unusual multifocal osteoarticular localizations including the wrist and tarsal joint which are rare and pleura-pulmonary tuberculosis.

Case presentation

Wrist, ankle, tarsal joint, hip and lung involvement was detected in a 30 year-old male patient. Mycobacterium tuberculosis was isolated from both synovial and pleural biopsy specimen cultures. The treatment was based on 9 months of antituberculosis drugs: rifampin (RMP), isoniazid (INH), pyrazinamide (Z) and ethambutol (EMB). INH (300 mg/day), RMP (600 mg/day), PZA (3gr/day) and EMB (1200 mg/day) were given for treatment 6 days/7. In the 4th week the patient’s condition improved and was discharged. After two months, the therapy was continued with INH and RMP up to 9 months. A hip replacement surgery and wrist Arthrodesis will be discussed after the patient’s total healing.

Conclusion

Tuberculous osteoarthritis is a frequently missed diagnosis, especially in different clinical patterns. A high level of suspicion is required particularly in high-risk populations and endemic areas. Well conducted treatment improves the prognosis.