Tuberculosis of the elbow joint: the complexity of diagnosis and treatment-A case report and review of literature.

Abstract

Background: Tuberculosis is one of the deadliest diseases worldwide, with an estimated incidence of more than 10 million new cases annually. As part of bone and joint tuberculosis (5-6% of all extrapulmonary tuberculosis cases), elbow tuberculosis is a rare manifestation-especially in the Western world-and is associated with nonspecific symptoms such as swelling, redness, and painful limitation of motion. This often leads to initial misdiagnoses, such as septic arthritis or rheumatoid arthritis, resulting in a significant delay in diagnosis and treatment.

Case presentation: A 27-year-old male patient from Bangalore, South India presented with left elbow pain and restricted motion. The clinical and imaging findings led to the suspicion of olecranon bursitis. Intraoperatively, joint tuberculosis was suspected; therefore, multiple tissue samples were taken and a diagnostic routine according to guidelines was initiated. The tuberculosis-specific interferon gamma test was positive and thus confirmed the patient's previous contact with Mycobacterium tuberculosis. Since extrapulmonary tuberculosis is often caused by multidrug-resistant mycobacterial strains, tuberculostatic therapy was started after obtaining the resistogram. Under the initiated therapy, a reduction in synovial inflammation on magnetic resonance imaging and a rehabilitation of the mobility of the elbow were achieved over a period of more than 15 months.

Conclusion: The basis for finding the diagnosis is a detailed, interdisciplinary diagnostic process, especially in patients with persisting unspecific symptoms, since joint tuberculosis is frequently the only site of manifestation. Despite the slow growth of mycobacteria, the microbiological findings, particularly the resistogram, should be awaited since extrapulmonary tuberculosis is often multidrug resistant. As shown in this case, surgical treatment is important for reliable diagnosis, including pathogen identification, but it is not mandatory for successful healing and regaining functionality of the affected joint.