Intra Operative Ziehl-Neelsen Test to Establish Diagnosis of Osteoarticular Tuberculosis Case: A Case Report and Literature Review from Multifocal Ostearticular Tuberculosis Case

Abstract

Background: Multifocal osteoarticular tuberculosis, one of the various forms of extrapulmonary tuberculosis, is uncommon. The symptoms are nonspecific, and the disease often presents with an indolent clinical course, usually leading to a delayed diagnosis as well as bone and joint destruction. Till now, golden standard of diagnosis is made by confirming Mycobacterium organism from biopsy. Methods: We deliver a case of sixteen-year-old boy patient with pain on bilateral ankle and left elbow since 1 month before admission, there was no history of previous trauma or known infection. Radiologic examination has been conduct but unconcluded. He was given antibiotic and NSAIDS but still yet to improve clinically. He then went to surgically open biopsy and run examination using wet prep dye from bone biopsy sample with Ziehl–Neelsen stain, compare by Acid Fast Bacillus (AFB) culture, PCR and histopathologic test. Result: Acid fast bacillus was found on wet prep dye with Ziehl-Neelsen stain in sample from left distal tibia. Diagnosis was made multifocal osteoarticular tuberculosis, which confirmed using AFB culture, PCR and histopathologic examination. We have done debridement and the patient receive anti tuberculosis therapy for nine months. Discussion: In this case report we want emphasize the use of wet prep dye with Ziehl-Neelsen stain intra operative to reduce waiting time result from histopathologic and microbiologic test which normally need several days to confirm the result.