SHM Converge Scientific Abstract ePoster Gallery-Crack in the Case: A Minor Fall Revealing Acetabular Tuberculosis

Pdf Summary

This case highlights the diagnostic challenge of musculoskeletal tuberculosis, a rare form of extra-pulmonary TB that often presents with vague, slowly progressive symptoms and may lack classic findings such as fever, night sweats, and weight loss until late. Although pulmonary TB is most common, extra-pulmonary TB is rising worldwide and now accounts for about 20% of cases. Bone and joint TB is uncommon and usually affects the spine, making acetabular involvement especially unusual.<br /><br />A 22-year-old Filipino man with no significant medical history presented with worsening left groin and hip pain two weeks after a minor fall. He had reduced range of motion and difficulty walking. Notably, he had also experienced dull hip pain for a week before the fall, suggesting an underlying process. Imaging showed a lytic lesion of the left acetabulum and a comminuted acetabular fracture, raising concern for malignancy or infection. Laboratory studies revealed elevated WBC, ESR, and CRP. Joint aspiration produced purulent fluid with lymphocyte predominance and markedly elevated LDH, but initial AFB and routine cultures were negative, so empiric antibiotics were started for possible pyogenic infection.<br /><br />Further testing revealed a highly elevated adenosine deaminase level in the joint fluid, and Mycobacterium tuberculosis PCR confirmed tuberculous joint infection. The patient was diagnosed with TB osteomyelitis of the acetabulum and started on RIPE therapy with outpatient infectious disease and orthopedic follow-up. On further history, he reported night sweats and subjective fevers over the prior month.<br /><br />The key lesson is that extra-pulmonary TB requires a high index of suspicion, especially in young patients with unexplained lytic bone lesions or persistent pain. Early diagnosis is critical to prevent further bone destruction and neurologic complications.

Asset Subtitle

Avery Hum

Meta Tag

Author List Avery Hum, Emma Kaplan-Lewis, Tanuja A. Prakash

Category Clinical Vignettes

Concept Musculoskeletal Tuberculosis

Concept RIPE Therapy

Concept Atypical Presentation

Concept Lytic Bone Lesions

Concept MTB PCR

Distinguished Non-Finalist

Presenter Organization Department of Medicine, NYC Health + Hospitals/ Elmhurst, Icahn School of Medicine at Mount Sinai

Presenting Author Avery Hum

Track Adult

Keywords

musculoskeletal tuberculosis

extrapulmonary TB

acetabular tuberculosis

TB osteomyelitis

lytic bone lesion

hip pain

joint aspiration

adenosine deaminase

Mycobacterium tuberculosis PCR

RIPE therapy

Musculoskeletal Tuberculosis

RIPE Therapy

Atypical Presentation

Lytic Bone Lesions

MTB PCR