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Background: Mycobacterium tuberculosis is a rare cause of prosthetic joint infection. We report a case of postoperative Mycobacterium tuberculosis infection after total knee arthroplasty.
Case: An 85-year-old woman who had continuous pain and swelling of the right knee for two months was evaluated by arthrocentesis, which revealed yellow synovial fluid. The synovial fluid culture was negative and so a diagnosis of osteoarthritis of the right knee was made. Total knee arthroplasty was undertaken and six weeks postoperatively, the synovial fluid culture and tissue biopsy yielded M. tuberculosis. Pulmonary tuberculosis was not detected on chest computed tomography or sputum examination. A diagnosis of tuberculous prosthetic joint infection was made, and anti-tuberculous therapy with isoniazid, rifampicin and ethambutol was initiated. At a 7-month follow-up, the radiography showed no signs of prosthesis loosening and C-reactive protein levels had returned to baseline without requiring prosthesis removal.
Conclusion: The early diagnosis of tuberculous prosthetic joint infection and appropriate treatment can produce good results without the need for prosthesis removal; the present case suggests the possibility of treatment of tuberculous prosthetic joint infection with anti-tuberculous chemotherapy alone in selected cases. When septic arthritis is suspected, tuberculous arthritis must also be considered.
