Tuberculous septic arthritis of the hip with large abscess formation mimicking soft tissue tumors: A case report

Abstract

Background: Tuberculous septic arthritis is an infection that occurs inside the joint or synovial fluid and joint tissues caused by Mycobacterium tuberculosis. It may show wide variability of clinical symptoms and imaging appearance, ranging from asymptomatic with a normal radiographic examination to severe joint pain along with joint destruction, osteomyelitis, and abscess formation. This article presents radiographic and MR imaging appearance from a case of tuberculous septic arthritis with large abscess formation mimicking soft tissue tumor. Case presentation: We reported a 32-year-old female with a slowly enlarging lump on her right proximal thigh within the last 4 months along with slowly progressing joint pain. Both radiographic and MR images showed destruction of the femoral head and acetabular roof, with a formation of large rim-enhanced abscess that extending superficially and distally until mid-thigh. The patient underwent open drainage surgery and excisional biopsy. Histopathological examination showed chronic granulomatous inflammation caused by tuberculous infection. Conclusion: MR imaging combined with radiographic and clinical information played a very important role in the diagnosis of tuberculous septic arthritis with abscess, and to differentiate it from soft tissue neoplasms.

Tuberculous Septic Arthritis of the Hip Following the Incision and Drainage of a Groin Abscess: A Case Report

“…Tuberculosis of the musculoskeletal system may present with various clinical manifestations that may not closely resemble a typical septic joint [ 5 , 6 ]. While it is important to consider this diagnosis in frail and immunocompromised patients, it is crucial to keep it in the differential diagnosis of healthy patients with no clear predisposing cause, especially when conventional treatment fails to achieve a satisfactory outcome.…”

“…While some cases such as that reported by Al-Tikrity et al showed more or less the typical form of primary tuberculosis with most of the salient features of tuberculosis of the hip such as pain, limitation of motion, and MRI features suggestive of tuberculosis [ 5 ], other cases such as the one published by Alsaleem et al showed a more insidious course with little or no manifestation of an acutely septic joint and with MRI features that are not specific to tuberculous arthritis [ 12 ]. Other studies reported a more unique presentation of hip tuberculous arthritis that resembled a soft tissue tumor [ 6 ]. This wide spectrum of manifestations presents a unique challenge to orthopedic surgeons and stresses the importance of a high index of suspicion when managing cases of septic arthritis of the hip.…”

“…Tuberculosis of the hip can present with very similar features and often with significant overlap with its pyogenic counterpart, which often complicates and delays accurate diagnosis and treatment [ 4 ]. In some cases, tuberculosis of the hip may present with vague symptoms, without the presence of fever or systemic manifestations of tuberculosis, or even as a soft tissue mass mimicking a neoplastic process [ 5 , 6 ]. The significant variation in clinical manifestation and overlap with a plethora of orthopedic diseases presents a challenge to orthopedic surgeons in the assessment and treatment of this increasingly rare disease.…”

Subclinical ankle joint tuberculous arthritis - The role of scintigraphy: A case series

“…Its slow progression and chronicity cause patients to present with subtle symptoms and signs, resulting in delayed diagnosis. The identification of people who have asymptomatic tuberculosis is a diagnostic challenge[ 8 , 9 ]. From a public health perspective, the concern is whether these people are infectious or not[ 10 ].…”