Abstract
A 33-year-old woman complained of arthralgia and swelling in the left knee without any provoking cause. After being treated with a single intra-articular injection of sodium hyaluronate in our outpatient clinic, the symptoms improved, but she later returned because the knee pain had recurred and was more intense. Marked swelling and patellar ballottement were observed, but the knee did not feel hot and there was no flare. Hematological data revealed a leukocyte count of 2970/μL, C-reactive protein 2+, erythrocyte sedimentation rate of 25 mm/h, negative rheumatoid factor (RF), and uric acid value of 3.3mg/dL. The synovial fluid was yellow and slightly cloudy, and examination for crystals revealed calcium pyrophosphate. Standard bacterial cultures and a tubercle bacillus culture were negative. An X-ray examination disclosed no abnormal findings, such as calcification. Since pseudogout was suspected, arthrocentesis, irrigation, and intra-articular injection of a steroid drug were preformed several times. However, the patient experienced recurrent bouts of hydrarthrosis and pain, and arthroscopy was performed. Histopathological examination of a biopsy specimen led to a diagnosis of tuberculous gonitis.
