Case Report

Infection

, Volume 36, Issue 3, pp 274-278

Disseminated Tuberculosis Following Total Knee Arthroplasty in an HIV Patient

  • J. MarschallAffiliated withDivision for Infectious Diseases, University Hospital InselspitalDivision of Infectious Diseases, Washington University School of Medicine
  • , J.-M. EvisonAffiliated withDivision for Infectious Diseases, University Hospital Inselspital
  • , S. DrozAffiliated withInstitute for Infectious Diseases, University of Bern
  • , U. C. StuderAffiliated withInstitute for Pathology, University of BernDivision of Internal Medicine, Regional Hospital Emmental
  • , S. ZimmerliAffiliated withInstitute for Infectious Diseases, University of Bern Email author 

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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.