Tuberculous Arthritis in the Ankle in an Immunocompetent Patient: a Case Report
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Tuberculous Arthritis in the Ankle in an Immunocompetent Patient: a Case Report Sergio Guillén-Martínez 1 & Marta Pareja León 2 & Elisa Martínez-Alfaro 3 & Fernando Mateos Rodríguez 3 & José Javier Blanch Sancho 3 & Juan Carlos Segura Luque 3 & Julián Solís García del Pozo 3 Accepted: 19 November 2020 / Published online: 25 November 2020 # Springer Nature Switzerland AG 2020
Abstract Osteoarticular tuberculosis comprises 1–3% of tuberculosis (TB) patients. In 50% of cases of osteoarticular TB affects the spine. Other joints, such as the ankle, hip, and knee, are less affected. The diagnosis may be delayed for months due to an indolent course and absence of specific signs. Here we report the case of a 42-year-old immigrant immunocompetent male with tuberculosis osteoarthritis of the ankle. The patient experienced intermittent arthritis episodes affecting the left ankle following a fracture of the calcaneus 4 years prior. Initial therapy with anti-inflammatory drugs and empirical antibiotics did not produce improvement. A histological study following a surgical biopsy of the bone provided the diagnosis of tuberculosis. The patient had no respiratory symptomatology, and the chest X-ray was normal. The patient improves his symptoms by administering antitubercular chemotherapy with isoniazid, rifampicin, pyrazinamide, and ethambutol. The diagnosis of osteoarticular TB requires a high index of suspicion, mainly in immunocompetent patients and in low-incidence countries. Keywords Infectious arthritis . Osteoarticular tuberculosis . Mycobacterium tuberculosis . Case report
Introduction According to the World Health Organization (WHO), there were approximately 10 million cases of tuberculosis (TB) in 2018, and a resulting 1.2 million deaths occurred worldwide. These numbers have remained relatively stable in recent years [1]. Spain is considered a low-incidence country, according to the European Center for Disease Prevention and Control (ECDC) [2]. At the time of writing, the latest ECDC/WHO joint report showed an incidence rate of between 9 and 11 patients per 100,000 inhabitants [2]. In 2015, 4191 cases were diagnosed in Spain. This rate shows a 14% decrease compared to that of 2014. Of these cases, 29.8% of patients were
immigrants [3]. Also, 910 patients had non-pulmonary tuberculosis and meningitis. Osteoarticular tuberculosis is a chronic inflammatory disease representing 1–3% of patients with tuberculosis [4, 5]. Because of its unspecific symptoms and its low incidence in developed countries, it constitutes a diagnostic challenge for clinicians. Sometimes cultures and biopsies do not show conclusive data; hence, articular tuberculosis requires a high grade of clinical suspicion. The history of previous tuberculosis, suggestive alterations in the chest X-ray, or the immunocompromised status, including patients under corticosteroid or immunosuppressive agents, can help in suspicion of TB infection [5, 6]. This article describes a case of tuberculous arthritis of the ankle in an immunocompetent patient at the
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