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Specific synovitis of a knee as the first manifestation of miliary tuberculosis

Tatjana Adzic1, Dragica Pesut1,2, Jelena Stojsic1, Ljudmila Nagorni-Obradovic1,2, Ruza Stevic1,2
1 Clinical Centre of Serbia, Institute of Lung Diseases and Tuberculosis, Research and Epidemiology Department,Belgrade, Serbia
2 School of Medicine University of Belgrade, Belgrade, Serbia

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Tuberculosis (TB) is declared global emergency. Miliary TB is a treatable, potentially lethal form of TB resulting from massive lymphohaematogeneous dissemination of Mycobacterium tuberculosis. Impaired cell-mediated immunity underlies the disease's development. We present a case of specific synovitis in a 21-year-old Caucasian HIV-seronegative woman. She presented with high fever and swelling of the right knee. Chest radiograph revealed bilateral nodular opacities in upper pulmonary lobes and signs of pleural effusions. Sputum samples were negative for Acid Fast Bacilli (AFB) and Löwenstein-Jensen (L-J) culture negative. Diagnosis was confirmed histologically by pleural biopsy and positive L-J cultures of knee punctation, also documented by MRI. Treatment outcome was successful with anti-tuberculous drugs following standardized treatment regimen.

Key words: Tuberculosis, disease, diagnosis, miliary, synovitis.