Pulmonary Tuberculosis with Delayed Tuberculosis Infection of Total Knee Arthroplasty

Abstract

Tuberculous prosthetic joint infection is rare. While early diagnosis is critical for treatment, it is usually delayed. Here, we present the case of a 72-year-old patient who underwent total knee arthroplasty for his right knee due to degenerative arthritis 4 years ago. Three years after arthroplasty, pulmonary tuberculosis was found and he hesitated on starting antituberculosis chemotherapy. He suffered from progressive pain and swelling of the right prosthetic knee for 2 months before this admission. The pathologic report of the debridement of the right prosthetic knee was caseous granulomatous inflammation with positive acid-fast staining bacilli. The culture of the debridement also yielded Mycobacterium tuberculosis. He died due to aspiration pneumonia with multiorgan dysfunction. This case is a reminder of the possibility of tuberculosis while dealing with prosthetic joint infection.

Mycobacterium tuberculosis prosthetic joint infections: A case series and literature review

“…Indeed, this situation is usually considered as a strong indication for revision arthroplasty, either one-or two-stage. However, in six cases of our series and 12 cases in the literature [2,9,22,25,34,41,42,46,49] This study has limitations. Firstly, due to its multicenter retrospective design over a long period of time (20 years), our case series has multiple potential biases: data collection and follow-up were not standardized, and the management probably differed not only from one center to another, but also over time.…”

Total Hip Arthroplasty Loosening Due to Mycobacterium Tuberculosis: A Case Report and Review of the Literature

“…But granulomas can also represent a reaction to the prosthesis or polyethylene wear debris. Acid-fast stains of the joint fluid are positive in 20-25% of the cases, while cultures are positive in approximately 60 to 80%; histological features are non specific [3,10].…”

“…The time from prosthesis implantation to manifestations of infection was variable, ranging from 1 month [9] to 38 years [8]. Patients usually presented with non specific clinical findings of an infected, painful and malfunctioning prosthesis [3,10].…”

“…If it remains stable components may be retained and medical treatment with or without debridement may suffice. This strategy was done and successful in fifteen cases [4,[7][8][9][10][11][12][13][14][15]. In the presence of component loosening or secondary bacterial infection, removal and staged revision is advised and achieved satisfactory outcomes in twelve cases [3][4][5][6]13,22,[24][25][26][27].…”

Mycobacterium tuberculosis as a Cause of Periprosthetic Joint Infection After Total Knee Arthroplasty: A Review of the Literature

“…of the lungs, or a second joint. Wang et al [22] reported on a 72-year-old male patient with a 50-year smoking history who developed a chronic cough and progressive knee pain one year following a TKA. Sputum cultures and knee synovial tissue culture confirmed the diagnosis to be TBPJI and pulmonary tuberculosis infection.…”