Case report s arun castro - the rarely hot knee final
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Transcript of Case report s arun castro - the rarely hot knee final
Radiograph demonstrating classic tuberculous arthritis
findings of Phemister’s triad: 1. Peripheral erosions. 2.
Juxta-articular osteoporosis. 3. Joint space loss.
The Rarely Hot Knee Dr S Arun-Castro MBBS PgDip PH
Clinical Fellow in Emergency Medicine, Newham University Hospital
Discussion:
Tuberculosis masquerades.
Experience tells us that tuberculosis is an
uncommon cause of knee mono-arthritis.
Epidemiology teaches us that whilst 47% of
disease is extra-pulmonary, only 2.5% is at
bony sites including the knee. [2]
If you see a hot knee, would you consider TB?
Abstract:
A 45 year old man with no rheumatological
history re-attended A&E with a swollen knee.
He had been discharged from Orthopaedics in
the previous month with the same problem
with a normal full blood count and joint
aspirate. His CRP was 120 and he was
discharged with anti-inflammatories.
Examination revealed a stiff, swollen, warm
knee with a temperature of 38.2C. Radiography
demonstrated Phemister’s triad.[1] Bloods
were unremarkable except for a still elevated
CRP.
As the 4 hour breech loomed closer, attention
turned to the previous joint aspirate. After 4
weeks, Acid Fast Bacilli had been detected,
making the diagnosis.
Words: 146 References: 1. Watts, R. Clunie, G. Hall,F. Marshall,T (2009). Oxford Desk Reference: Rheumatology. Oxford: Oxford University Press. 472. 2. Public Health England. (2013). Tuberculosis case reports by site of disease, UK, 2012. Enhanced Tuberculosis Surveillance (ETS). http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317139694870#