Musculoskeletal Tuberculous Arthritis Mimicking Septic Arthritis

A young woman presented with left hip pain for one week. She had been admitted to another hospital one month prior for right ankle pain and was undergoing treatment for septic arthritis with home IV antibiotics. Imaging of the left hip and right ankle was consistent with septic arthritis, but washout of the left hip and right ankle yielded negative gram stain and bacterial cultures. Due to persistent fevers, further imaging revealed miliary tuberculosis, and AFB testing of the washout fluid from the right ankle eventually resulted positive for Mycobacterium tuberculosis. The patient was placed on airborne isolation and started on Rifampin, Isoniazid, Pyrazinamide and Ethambutol for a duration of one year.