Tubercular Synovitis of Knee presenting with Diabetic Ketoacidosis in a patient with multiple comorbidities.

Abstract

Introduction: Mono-articular tuberculosis in hip and knee tend to present with late features - articular cartilage destruction, muscle wasting, contractures, and deformity. Comorbidities such as diabetes predispose a patient to infections.

Purpose: Herein, we present a case of tuberculosis of the knee with rare presenting features.

Case report: A 74-year-old male, previously non-diabetic, presented to our emergency with features of diabetic ketoacidosis. His urine and blood cultures showed no growth. The physiotherapist noted hamstring spasm pain on motion, knee held at 30°, marked effusion (6th day). Purulent 40 cc aspirate was drained. No organism was found (Gram stain, India ink, or AFB) or culture (aerobic, anerobic, and fungal) but aspirate showed marked leukocytosis and raised CRP. USG reported fibrotic lining and the presence of synovial fronds. A history of fatigue, weight loss, and anorexia was elicited. Nodes were impalpable, and the chest was normal. CBNAAT came out negative. The presence of pacemaker implanted 10 years back prevented us from getting a MRI. Biopsy considering diabetes, the procedure was out off. The pulmonologist diagnosed him with smear-negative TB. Anti-tubercular drugs were started.

Conclusion: Early detection of tubercular synovitis is based on clinical suspicion and may prevent the development of bony deformity.