Published online Dec 28, 2017. doi: 10.4329/wjr.v9.i12.454
Peer-review started: September 19, 2017
First decision: October 23, 2017
Revised: November 9, 2017
Accepted: November 27, 2017
Article in press: November 27, 2017
Published online: December 28, 2017
A case of tubercular arthritis who underwent a number of investigations in suspicion of malignancy, each one adding to the confusion rather than helping in arriving diagnosis.
Infective arthritis of hand.
Rheumatoid arthritis; Septic arthritis; Primary or secondary malignancy.
Demonstration of Mycobacterium tuberculosis on culture of bone tissue/positive Ziehl-Neelsen staining/rapid PCR DNA detection.
Radiography: Juxta-articular osteopenia, subarticular erosions and joint space narrowing, with or without soft tissue component. MRI: Synovitis, joint effusion, subarticular erosions, active and chronic pannus, abscesses, hypo-intense synovium and bone chips.
Features favoring tubercular infection as granulomas with caseous necrosis in synovial tissue and bone.
Skeletal tuberculosis including arthritis are treated with 9-12 mo of anti-tubercular drug regimen.
Several cases of tubercular involvement of small joints of hand are reported in literature. In most of the cases, septic and rheumatoid arthritis were considered as differential diagnosis. Two cases of tubercular arthritis mimicking neoplasm have been reported.
VOMIT: Victims of modern imaging technology; Phemister’s triad: Juxta-articular osteopenia, subarticular erosions and joint space narrowing.
Following standardized guidelines reduces the errors in diagnostic and treatment workflow. While making of provisional diagnosis, a radiologist should think of common disease over uncommon diseases. A free and open discussion among clinicians, radiologists and pathologists should be encouraged.