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LETTER TO EDITOR
Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 67-68

Tuberculosis of patella


1 Sanitation 1 Medical Academic Center, Bangkok, Thailand
2 Department of Tropical Medicine, Hainan Medical University, Haikou, China

Date of Web Publication1-Mar-2018

Correspondence Address:
Dr. Beuy Joob
Sanitation 1 Medical Academic Center, Bangkok
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_129_17

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How to cite this article:
Joob B, Wiwanitkit V. Tuberculosis of patella. Int J Health Allied Sci 2018;7:67-8

How to cite this URL:
Joob B, Wiwanitkit V. Tuberculosis of patella. Int J Health Allied Sci [serial online] 2018 [cited 2021 Jan 23];7:67-8. Available from: https://www.ijhas.in/text.asp?2018/7/1/67/226254



Sir,

We read with interest the article on “Tuberculosis (TB) of patella.”[1] Sharma et al. concluded that “isolated TB of patella is very rare, so early diagnosis and management is quite difficult without clinical and histopathological examination.[1]” In fact, bone TB can be primary and it can occur at any organ. The patient usually has the immunocompromised status.[2] The diagnostic clue by imaging is “osteolytic lesion in the patella with flaky sequestrum, associated with typical clinical features.[3]” This presentation is an important hallmark of the TB patella which is specific. Whereas, Sharma et al. proposed that the case might have nonspecific presentation; the imaging finding with clinical history can be a clue for presumptive diagnosis. In addition, the confirmation might be by new tuberculosis laboratory test. Referring to the basic concern in good history taking and early diagnosis, Goyal and Sharma recently reported “two cases of tuberculosis of the patella presenting as an osteolytic lesion with sequestrum [4]” and concluded that “timely diagnosis helped in successful management of both these cases, resulting in complete resolution of symptoms with a functional knee without need for patellectomy.[4]” For clinical practitioner, the presumptive diagnosis of patella tuberculosis might be possible for any cases with unexplained chronic knee synovitis with pathognomonic imaging finding. For confirmation, the specific laboratory test is required. Ellis et al. noted that “the highest diagnostic yield was with a combination of synovial histology, synovial fluid culture, and direct smear examination for acid-fast bacilli.[5]” Nevertheless, the final diagnosis usually requires invasive procedures. Starting of anti-TB drug might be both diagnostic and therapeutic approach [Figure 1].
Figure 1: Steps for diagnosis and treatment of tuberculosis of patella

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Another important question on the present case is whether it is an actual isolated TB at patella. Without complete whole-body scan, it cannot ensure that there might not any other silent foci of TB in the patient. Indeed, if a patient has the underlying immunodeficiency problem, the musculoskeletal tuberculosis might occur and there is usually the problem of atypical tuberculosis infection at lung or lymph node.[5],[6] Furthermore, according to the recent report by Adzic et al.,[7] the tuberculosis at knee might be only the first presentation of the miliary TB. As noted by Vasil'ev, the hidden TB at internal organs is very common in cases with TB at bone and joint.[8] Lack for complete whole-body scan might be the root cause of underdiagnosis of hidden TB, and this can easily lead to the conclusion that there is only isolated TB patella.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sharma PK, Madegowda A, Mittal R. Tuberculosis of patella: Nonspecific presentation, treated conservatively. Int J Health Allied Sci 2017;6:194-6.  Back to cited text no. 1
  [Full text]  
2.
Agrawal VK, Agrawal RG. Tuberculosis of patella in an immunocompetent patient – A case report. Indian J Tuberc 2011;58:29-31.  Back to cited text no. 2
    
3.
Dhillon MS, Rao SS, Sandhu MS, Vasisht RK, Nagi ON. Tuberculosis of the patella. Skeletal Radiol 1998;27:40-2.  Back to cited text no. 3
    
4.
Goyal D, Sharma PK. Isolated tuberculosis of the patella – Report of two cases and review of the literature. Bull Hosp Jt Dis (2013) 2014;72:237-41.  Back to cited text no. 4
    
5.
Ellis ME, el-Ramahi KM, al-Dalaan AN. Tuberculosis of peripheral joints: A dilemma in diagnosis. Tuber Lung Dis 1993;74:399-404.  Back to cited text no. 5
    
6.
de Araujo PS, de Melo HR, de Melo FL, Medeiros Z, Maciel MA, Florêncio R, et al. Multifocal skeletal tuberculosis in an immunocompetent patient: A case report. BMC Infect Dis 2015;15:235.  Back to cited text no. 6
    
7.
Adzic T, Pesu D, Stojsic J, Nagorni-Obradovi L, Stevi R. Specific synovitis of a knee as the first manifestation of miliary tuberculosis. Pneumologia 2008;57:156-7.  Back to cited text no. 7
    
8.
Vasil'ev PG. Diseases of the internal organs in patients with bone and joint tuberculosis. Probl Tuberk 1989;10:36-8.  Back to cited text no. 8
    


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