Brucellar Knee Arthritis with Knee Joint Tuberculosis: A Case Report and Review of the Literature

Figures & data

Figure 1 On admission to the hospital, X-ray and MRI images were taken of the left knee joint. (A and B) An X-ray of the distal femur and the proximal tibia revealed patches of osteopenia (blue circle). (C–E) There was a synovial infection in the knee joint, a localized full-thickness defect in the patellar cartilage (red arrow), and a diffuse patchy signal in the bone marrow on T2-weighted imaging (red circle).

Figure 2 Brucella melitensis was detected by real-time PCR, real-time PCR showed that the DNA content of Brucella melitensis (Solid red line) increased in 32 cycles.

Figure 3 Pathological staining of knee joint effusion and inflammatory tissue. (A) Inflammatory cell infiltration was seen by HE staining. (B) Acid-fast staining was negative.

Figure 4 After five years, X-rays and MRI scans of the left knee joint were taken. (A and B) The X-rays showed that the distal femur and proximal tibia had resolved from the previous abnormal X-ray appearances. (C–E) It was also noted that the MRI changes were largely resolved.

Table 1 Literature Review of Knee Joint Tuberculosis with Mixed Infections

Author	Infection Type	Clinical Characteristics	Method of Diagnosis	Treatment Regimen	Clinical Outcomes
Kumar et al (2016)^Citation6	Aspergillus and tuberculosis	Irregular fever and increasing pain in right hip and knee	Bacterial culture, acid fast bacilli culture, fungal culture, TB polymerase chain reaction, synoviumbiopsy	Debridement, intravenous voriconazole, and antitubercular drugs	Well
Kuner et al (2019)^Citation7	Mycobacterium bovis and Candida guilliermondii	Persistent swelling of the knee and persistent wound scab	Bacterial culture, scintigraphy, tissue sampling and sonication of all implant parts	Tuberculostatic and mycocide medication, a two-stage revision knee arthroplasty	Well
Opara et al (2007)^Citation8	Staphylococcus aureus and tuberculosis	Pain in the left knee, fever and swelling in the popliteal fossa; worsening pain, swelling, and stiffness of left knee	Bacterial culture, acid-fast bacilli culture, synovialbiopsies	Incision and drainage of the popliteal swelling, arthroscopic lavage, splintage and flucloxacillin with fusidic acid, anti-tuberculous quadruple therapy	Persistent destructive changes in the joint
Remalante-Rayco et al (2021)^Citation9	Mycobacterium tuberculosis, Pseudomonas aeruginosa, Acinetobacter baumannii	Right knee swelling with fungating masses and white-yellow discharge	Acid-fast bacillus smear, Mycobacterium tuberculosis PCR test, aerobic culture, and histopathology	Antibiotic therapy, debridement, partial synovectomy, arthrotomy, and a flap coverage with split-thickness skin graft	Well

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Kuner E, Jöckel JA, Orler R, Nüesch R. Periprosthetic knee infection by Mycobacterium bovis and Candida guilliermondii in the context of a zoonosis: a case report and review of the literature. J Med Case Rep. 2019;13(1):54. doi:10.1186/s13256-019-2009-8

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Remalante-Rayco PP, Dumlao PIE, Santiago AT. Great imitator: an unusual presentation of osteoarticular tuberculosis of the knee with gram-negative bacterial arthritis. BMJ Case Rep. 2021;14(11):e245583. doi:10.1136/bcr-2021-245583.112-4

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