Infection

, Volume 36, Issue 3, pp 274–278

Disseminated Tuberculosis Following Total Knee Arthroplasty in an HIV Patient

  • J. Marschall
  • J.-M. Evison
  • S. Droz
  • U. C. Studer
  • S. Zimmerli
Case Report

DOI: 10.1007/s15010-007-7011-1

Cite this article as:
Marschall, J., Evison, J., Droz, S. et al. Infection (2008) 36: 274. doi:10.1007/s15010-007-7011-1

Abstract

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.

Copyright information

© Urban & Vogel München 2007

Authors and Affiliations

  • J. Marschall
    • 1
    • 4
  • J.-M. Evison
    • 1
  • S. Droz
    • 2
  • U. C. Studer
    • 3
    • 5
  • S. Zimmerli
    • 2
  1. 1.Division for Infectious DiseasesUniversity Hospital InselspitalBernSwitzerland
  2. 2.Institute for Infectious DiseasesUniversity of BernBernSwitzerland
  3. 3.Institute for PathologyUniversity of BernBernSwitzerland
  4. 4.Division of Infectious DiseasesWashington University School of MedicineSt. LouisUSA
  5. 5.Division of Internal MedicineRegional Hospital EmmentalBurgdorfSwitzerland