Tuberculosis Septic Arthritis of the Elbow: A Case Report and Literature Review

Abstract

Tuberculosis (TB) infections of the musculoskeletal system are rare. A 77-year-old female with chronic left elbow pain for five months was treated by irrigation and debridement of the elbow for a presumed diagnosis of septic arthritis. Her pain and wound condition did not improve, and she was referred to our institution. Plain radiograph and magnetic resonance imaging (MRI) revealed an osteolytic lesion with joint effusion and severe destruction of the elbow joint. We suspected an atypical infection of the elbow due to the chronicity, negative culture results and severe osteoarticular destruction. An open arthrotomy with irrigation and debridement was performed, and the joint was stabilized with a pin and immobilized. A tissue acid-fast bacillus (AFB) stain was positive and Mycobacterium tuberculosis culture and polymerase chain reaction (PCR) were also positive. Anti-TB drugs were started for a planned 12-month course, but she developed an adverse drug reaction from the standard regimen and had to be switched to a second-line regimen. The stitches were removed at two weeks and the wound eventually healed. The elbow was immobilized in a posterior slab for six weeks then the pin was removed. At the last follow-up visit seven months after the initial surgery, she had improved, with only mild pain on elbow motion. Her range of motion was 110 degrees of flexion and extension lag of 30 degrees. TB of the elbow is a rare condition. The presentation is insidious and varies, and can be confused with other elbow conditions. Delayed diagnosis can lead to severe joint destruction and poor outcome. The physician should always suspect a TB elbow in cases of chronic elbow pain with synovitis, especially in areas endemic for TB. Joint fluid aspiration and MRI are the most reliable investigations for diagnosis. Anti-TB drugs are the mainstay of treatment. Appropriate surgical interventions such as drainage, synovectomy and reconstructive procedures will often be required. Collaboration between the orthopedist and an infectious specialist is essential for optimal treatment planning.

Pengetahuan dan Praktik Keluarga Mengenai Pencegahan Komplikasi Imobilisasi

“…Pencegahan komplikasi imobilisasi mungkin lebih hemat biaya daripada pendekatan terapeutik. Keluarga perlu memiliki pengetahuan tentang pentingnya mencegah komplikasi imobilisasi seperti deep vein thrombosis, pneumonia, dan luka dekubitus (Tangadulrat & Suwannaphisit, 2021). Tujuan dari penelitian ini adalah untuk menilai pengetahuan dan praktik keluarga pasien yang mengalami imobilisasi mengenai pencegahan komplikasi terkait imobilisasi.…”