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Great imitator: an unusual presentation of osteoarticular tuberculosis of the knee with gram-negative bacterial arthritis
  1. Patricia Pauline Remalante-Rayco1,
  2. Patricio III Espinoza Dumlao2 and
  3. Angeline-Therese Santiago1
  1. 1Division of Rheumatology, Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines
  2. 2Department of Orthopedics, University of the Philippines - Philippine General Hospital, Manila, Philippines
  1. Correspondence to Dr Patricia Pauline Remalante-Rayco; pmremalante{at}


A 33-year-old man presented with a 2-year history of right knee swelling with fungating masses and white-yellow discharge. Severe pain, limited movement and signs of sepsis were absent. Debridement, partial synovectomy and arthrotomy were done for the multiple sinuses that developed over the knee. Synovial tissue analysis yielded a positive acid-fast bacillus smear and Mycobacterium tuberculosis PCR test, while aerobic culture studies grew Pseudomonas aeruginosa and Acinetobacter baumannii. Chronic granulomatous inflammation was seen on histopathology. Alongside antibiotic therapy, multiple debridements of the right knee were required to eradicate the infection and allow wound repair. A flap coverage with split-thickness skin graft was performed after the bacterial infection resolved, and the patient was discharged ambulatory with minimal pain. Such atypical presentations of monarthritis require immediate workup and a prompt referral to a multidisciplinary team to establish the diagnosis and initiate appropriate management before irreversible joint destruction and disability ensues.

  • rheumatology
  • bone and joint infections
  • orthopaedics

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  • Contributors PPR-R is the primary author of the paper and attending physician of the patient. PIED is the coauthor of the paper and is the patient’s comanaging physician. A-TS is the adviser and coauthor of the paper who provided insights into the content of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.