2002 OITE Question 255

Question

A 38 year old man with acquired immunodeficiency syndrome has had gradually progressive left groin pain for the past 2 years. A plain radiograph, a biopsy specimen, and results of an acid-fast stain are shown in fig. 69a through 69c. Management should consist of

1) observation

2) antimicrobial chemotherapy

3) synovectomy with curettage and bone grafting of the cysts

4) total hip arthroplasty

5) internal hemipelvectomy

Figures

Answer (click for answer)

Preferred Response: 2

Mycobacterium TB is a very uncommon cause of septic arthritis in developed countries, and thus when present is often misdiagnosed as other forms of arthritis such as rheumatoid. It clinical and radiographic courses do infact closely mimic other inflammatory arthriditis early on, however, as the infection progresses severe joint and bone stock destruction subsequently occur. First line treatment is antimicrobial with multi drug therapy based on Bx obtained sensitivities. The advantage of antimicrobial rx is preservation of joint integrity. Open debridement is reserved for those cases with severe destruction of the joint and underlying bone.

Reference: Silber JS, Insidious Destruction of the hip by Mycobacterium tuberculosis and why early diagnosis is critical. J Arthroplasty 2000; 15:392-397