DESCRIPTION

Tuberculosis case detection remains diffi cult, partly because of atypical clinical presentations. We present an atypical tuberculosis monarthritis of the hand. 1 2 A 66-year-old man with refractory anaemia with excess of blasts and cryptogenic cirrhosis presented an indolent joint swell-ing of the third metacarpal on the left hand. Radiographs showed destructive changes within the joint and in peri-articular structures ( fi gure 1). Chest x-ray was normal. The Zielh–Nielsen test of articular tissue obtained by needle biopsy identifi ed acid-fast bacilli. Löwenstein cul-ture revealed Mycobacterium tuberculosis. An initial 2-month intensive phase therapy included isoniazid (300 mg/d), ethambutol (15 mg/d), rifampin (600 mg/d) and pyrazi-namide (2 g/d) because the patient was immunocompro-mised despite being HIV-negative. Daily therapy with isoniazid and rifampin was continued for an additional 16 months. Minimal articular disability was observed at the completion of therapy. An indolent tumour in a joint should include tuberculosis in the differential diagnosis of destructive osteoarticular lesions so as to avoid permanent articular-associated disability. Competing interests None. Patient consent Obtained