, Volume 36, Issue 3, pp 274–278

Disseminated Tuberculosis Following Total Knee Arthroplasty in an HIV Patient


  • J. Marschall
    • Division for Infectious DiseasesUniversity Hospital Inselspital
    • Division of Infectious DiseasesWashington University School of Medicine
  • J.-M. Evison
    • Division for Infectious DiseasesUniversity Hospital Inselspital
  • S. Droz
    • Institute for Infectious DiseasesUniversity of Bern
  • U. C. Studer
    • Institute for PathologyUniversity of Bern
    • Division of Internal MedicineRegional Hospital Emmental
    • Institute for Infectious DiseasesUniversity of Bern
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


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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© Urban & Vogel München 2007