An uncommon cause of elbow pain: a case report of tuberculosis of soft tissues

Abstract

Introduction: Extrapulmonary tuberculosis is found in 29% of cases in Portugal. The most common sites are lymph nodes, pleura, bone, joints, and meninges. The high prevalence of tuberculosis in Portugal and the scarcity of reported cases of tuberculosis of soft tissues highlight the importance of this case report. Case presentation: A 17 year-old female was healthy until February of 2013 when she began to complain of pain on movement of the right elbow. There was no history of trauma. She was treated with anti-inflammatory medication. Because of persistent pain and the appearance of signs of local inflammation, an ultrasound examination of the elbow was requested by the family doctor. This revealed an area of edema and cellulitis in the peri-articular soft tissues. After failure of treatment with two courses of oral antibiotics, she went to the emergency department of Centro Hospitalar Póvoa do Varzim/Vila do Conde where she was admitted to the pediatric department. She presented with swelling of the lateral aspect of the elbow with fluctuation and tenderness to palpation, but without restriction of mobility of the joint. A local aspiration was performed and culture of the fluid was positive for Mycobacterium tuberculosis. The tuberculin skin test showed an induration of 13 mm. Nuclear magnetic resonance imaging of the elbow was suggestive of an infectious lesion of tuberculosis etiology. The patient was referred to the Centre for Pulmonary Diagnosis with a diagnosis of tuberculosis of soft tissues. She began triple tuberculostatic therapy, with clinical improvement after one month of treatment. Discussion: Although it is rare, tuberculosis of soft tissues should be considered in localized, persistent lesions that are resistant to antibiotic treatment, especially in geographical areas with a high prevalence of tuberculosis.