Case Report

Tuberculous Arthritis: A Forgotten Diagnosis During Pandemic Covid-19


Tuberculosis (TB) is a respiratory disease that primarily affects the lungs. The challenge is to recognize the characteristic of TB disease, including extrapulmonary presentation. TB arthritis is an extrapulmonary TB presentation in the joint, which is frequently neglected and misdiagnosed. A 41-year-old female patient was presented with a major complaint of chronic pain in her left wrist for three months. The patient had a low-grade fever without respiratory symptoms. Local examination revealed swelling, warmth and tenderness. Erythrocyte sedimentation rate (ESR) was increased and chest radiograph demonstrated pulmonary TB. She underwent arthrotomy debridement and culture examination. We initiated adjuvant anti-tuberculous treatment. On the evaluation, she reported relief from pain and showed improvement in general condition. TB arthritis is unique due to its rare incidence and unspecific clinical manifestations. A better understanding of these issues will prevent possible diagnostic errors. Prompt treatment was crucial to maintain joint function and prevent permanent destruction.

1. Zaman K. Tuberculosis: A global health problem. J Heal Popul Nutr. 2010;28(2):111-113. v28i2.4879
2. Thimmaiah VT, Deepashree. Unusual Presentation of Tuberculosis of Elbow Joint : A Case Report. J Med Heal Sci. 2013;2(4):17-20.
3. Favalli EG, Ingegnoli F, De Lucia O, Cincinelli G, Cimaz R, Caporali R. COVID-19 infection and rheumatoid arthritis: Faraway, so close! Autoimmun Rev. 2020;19(5):102523. https://doi. org/10.1016/j.autrev.2020.102523
4. Covid-19 Coronavirus Pandemic. Published 2020. Accessed May 1, 2021.
5. Lee JY. Diagnosis and treatment of extrapulmonary tuberculosis. Tuberc Respir Dis (Seoul). 2015;78(2):47-55. https://doi. org/10.4046/trd.2015.78.2.47
6. Sari A, Dinçel YM, Erdogdu IH, Sayıner HS, Agir I, Çetin MÜ. Tuberculosis osteomyelitis of the tibia mimicking Brodie abscess: A case report and review of the literature. SAGE Open Med Case Reports. 2019;7:2050313X1986945. https://doi. org/10.1177/2050313x19869455
7. Chou Tseng C. Tuberculosis Arthritis: Epidemiology, Diagnosis, Treatment. Clin Res Foot Ankle. 2014;02(02). https://doi. org/10.4172/2329-910x.1000131
8. Sagoo RS, Lakdawala A, Subbu R. Tuberculosis of the elbow joint. JRSM Short Rep. 2011;2(3):1-3. shorts.2011.010130
9. Haldar S, Ghosh P, Ghosh A. Tuberculous arthritis - The challenges and opportunities: Observations from a tertiary center. Indian J Rheumatol. 2011;6(1 SUPPL.):62-68. https://
10. Pigrau-Serrallach C, Rodríguez-Pardo D. Bone and Joint Tuberculosis. Eur Spine J. 2013;22(SUPPL.4):556-566. https://
11. Gunawan, Harahap A, Setiyohadi B, Rumende CM. Tuberculous osteomyelitis in an immunocompetent patient with miliary tuberculosis. Indones J Rheumatol. 2010;02:41-44. https://doi. org/10.37275/ijr.v2i3.83
12. Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: A radiologic review. Radiographics. 2007;27(5):1255-1273.
13. Jung SS, Lee MK, Lim SH, Kwon YM, Choi SS. Elbow pain proven to be tuberculous arthritis -A case report. Korean J Anesthesiol. 2010;58(2):211-214. kjae.2010.58.2.211
14. Piccazzo R, Paparo F, Garlaschi G. Diagnostic accuracy of chest radiography for the diagnosis of tuberculosis (tb) and its role in the detection of latent TB infection: A systematic review. J Rheumatol. 2014;41(SUPPL. 91):32-40. https://doi. org/10.3899/jrheum.140100
15. Saktiawati AMI, Subronto YW, Stienstra Y, Sumardi, Supit F, Van Der Werf TS. Sensitivity and specificity of routine diagnostic work-up for tuberculosis in lung clinics in Yogyakarta, Indonesia: A cohort study. BMC Public Health. 2019;19(1):1-11. https://
16. Yang CY, Guo HR, Cheng YY, Huang RM. Factors associated with misdiagnosis of smear-negative tuberculosis: An experience in Taiwan. Respir Care. 2012;57(5):753-757. https://doi. org/10.4187/respcare.01454
IssueVol 7 No 6 (2022): November-December QRcode
SectionCase Report(s)
Wrist joint Tuberculous arthritis Extrapulmonary tuberculosis Anti-tuberculous chemotherapy

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How to Cite
Huwae T, Pribadi A. Tuberculous Arthritis: A Forgotten Diagnosis During Pandemic Covid-19. CRCP. 2023;7(6):268-274.