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Clinical Problem Solving: Radiology
Feb 2012

Radiology Quiz Case 1: Diagnosis

Author Affiliations
 

SECTION EDITOR: C. DOUGLAS PHILLIPS, MD

Arch Otolaryngol Head Neck Surg. 2012;138(2):198. doi:10.1001/archoto.2011.1161b

Diagnosis: Tuberculous arthritis of the TMJ

Mycobacterium tuberculosis (TB) infection is a worldwide disease. An estimated 14 million cases occurred in 2009, with especially high prevalence rates in Asia and Africa.1 The lung is the most commonly affected site. However, the infection can also occur in extrapulmonary sites such as lymph nodes, spine, and joints.2,3 Tuberculous infection of joints often appears as monoarthritis. Weight-bearing joints such as the hip and knee are most commonly affected, but the involvement of small joints of the extremities has also been reported. In most cases, the infection leads to bony destruction and spread to adjacent soft tissues. Tuberculous arthritis is usually difficult to diagnose, and only a small percentage of cases involve concomitant pulmonary infection. On the other hand, patients with extrapulmonary TB usually do not have classic symptoms such as low-grade fever, cough, weight loss, anorexia, and night sweating.4 As a result, tuberculous arthritis is often diagnosed late and is followed by joint destruction with limitation of movement.

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