Tuberculosis arthritis (TB) is an infrequent form of extra-pulmonary manifestations accounting for 10‒11% of cases (1). It is usually of monoarticular involvement, affecting the large weight-bearing joints. Spread is usually hematogenous from distant sites such as lungs or kidneys. The disease can progress from periarticular and bony erosions to joint destruction. Establishing the diagnosis is usually delayed because early symptoms are gradual in onset. In active TB arthritis, constitutional symptoms such as fever, night sweats or weight loss can be present but may not be seen. Signs of pulmonary and chest X-ray findings are inconspicuous; pulmonary TB is only seen in less than 50% of persons diagnosed with TB arthritis (1). Here, this case reveals the under recognized presentation and diagnosis of TB arthritis and the importance of taking a sound clinical history. A delay in its diagnosis also leads to a delay in its management and increased risk of complications.
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