Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2023; 14(4): 260-267
Published online Apr 18, 2023. doi: 10.5312/wjo.v14.i4.260
Subclinical ankle joint tuberculous arthritis - The role of scintigraphy: A case series
Raden Andri Primadhi, Achmad Hussein Sundawa Kartamihardja
Raden Andri Primadhi, Department Orthopaedics and Traumatology, Universitas Padjadjaran/ Hasan Sadikin Hospital, Bandung 40161, Indonesia
Achmad Hussein Sundawa Kartamihardja, Departement of Nuclear Medicine and Molecular Imaging, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung 40161, Indonesia
Author contributions: Primadhi RA performed the majority of the writing and figure preparation; Kartamihardja AHS provided input and correction into the paper writing.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Raden Andri Primadhi, MD, PhD, Assistant Professor, Surgeon, Department Orthopaedics and Traumatology, Universitas Padjadjaran/Hasan Sadikin Hospital, Jalan Pasteur 38, Bandung 40161, Indonesia. randri@unpad.ac.id
Received: January 13, 2023
Peer-review started: January 13, 2023
First decision: January 31, 2023
Revised: February 6, 2023
Accepted: March 23, 2023
Article in press: March 23, 2023
Published online: April 18, 2023
Abstract
BACKGROUND

Tuberculosis remains a complicated problem. A lack of awareness accompanied by difficulty in diagnosis hinders the management of tuberculosis. Delayed management, particularly in osteoarticular regions, results in unnecessary procedures, including joint-sacrificing surgery.

CASE SUMMARY

Three cases of subclinical ankle joint tuberculosis without clear signs of tuberculosis were presented. The efficacy of technetium-99m-ethambutol scintigraphy in diagnosing early-stage tuberculous arthritis is reported.

CONCLUSION

The reports suggested that scintigraphy is recommended to diagnose subclinical tuberculous arthritis, especially in tuberculosis endemic regions.

Keywords: Ankle, Infectious arthritis, Ethambutol, Scintigraphy, Tuberculosis, Case report

Core Tip: Tuberculosis may present in a subclinical state that hindered the diagnosis and subsequent management. Technetium-99m-ethambutol scintigraphy is a useful noninvasive method to detect early stage of joint tuberculosis in which morphological and laboratory changes are still unclear. By using this method, earlier diagnosis and prompt intervention can be made especially in tuberculosis endemic regions, to avoid unnecessary procedures resulting from disease advancement.