PMC7235927_01
Knee Radiograph.. (a) In 19 November 2013, it is shown the narrowing of knee joint gap. (b) In 18 January 2016, it can be observed that there has been a lytic lesion with ill-defined in periarticular projection in right proximal tibia and there was an ill-defined focal thickening in suprapatella and posterior of the right knee suspected a primer bone lesion in peri-articular proximal tibia
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In 2013, there was only a narrowing of the joint gap (Fig. 1a). Still, after being ignored for 3 years, it has progressed to the bone destruction, which was indicated by the presence of a lytic lesion in both fibula and tibia (Fig. 1b).
MRI examination of the knee.. (a) Based on coronal view, it showed well-defined iso-hyperintensed lesion and fat-set epimetaphysis femur (distal); tibia-fibula epimetaphysis (proximal); half of right inferior patella pole. (b) In sagittal T2 posterior projection of right genu, there was an iso-hyperintense mass that involved half of musculus gastrocnemius (mediolateral), plantaris, popliteal, and half of femoral arterial and venous and tibial nervesagittal view. (c) From the axial view, there was a free fluid collection in which dominant in suprapatella and minimal infrapatella projection.
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Imaging (MRI) was used later. It showed the well-defined iso-hyperintense mass and free fluid collection that lead to right tuberculous knee arthritis with posterior abscess and synovitis infection (Fig. 2).
The macroscopic and microscopic appearance of tuberculosis of the knee.. (a) The macroscopic examination showed the isolated of synovium destruction with cold abscess. (b) The microscopic examination revealed epitheloid proliferation, granuloma, necrotic, lymphocyte infiltration, and localized fibrosis, suspect of chronic specific inflammation including tuberculosis mass.
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The medial incision of the right patella revealed the synovial mass without any attachment to the adjacent structure (Fig. 3a). Later, histopathology revealed the epitheloid proliferation, granuloma, necrotic, lymphocyte infiltration, and localized fibrosis, suspecting a chronic specific inflammation, which included tuberculosis mass (Fig. 3b).
In coronal and sagittal view showed the prominent lytic lesion in femur, tibia-fibula bone.
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MRI was performed, and it showed the more prominent of the lytic lesion compared with the previous MRI without secondary infection (Fig. 4).