# A major pain in the hip - Destruction of the left acetabulum and femoral head secondary to Tuberculosis: A case report and review of the literature

## TL;DR

A 68-year-old man with hip pain and a history of travel to Zambia was diagnosed with tuberculosis affecting his hip joint, highlighting the need for prompt diagnosis and multidisciplinary care.

## Contribution

This case emphasizes the importance of considering tuberculosis in joint erosion and the utility of whole genome sequencing for timely diagnosis.

## Key findings

- Tuberculosis caused destruction of the acetabulum and femoral head in a patient with a history of hip pain and travel to Zambia.
- Whole genome sequencing confirmed drug-sensitive Mycobacterium tuberculosis, enabling targeted treatment.
- A multidisciplinary approach is crucial for managing complex cases of musculoskeletal tuberculosis.

## Abstract

•Tuberculosis.•Orthopaedics.•Multi-disciplinary team.•Infections.

Tuberculosis.

Orthopaedics.

Multi-disciplinary team.

Infections.

A 68-year-old-gentleman presented with left hip pain, night sweats, fatigue, and weight loss. He had previously experienced pain with white discharge until he underwent an arthroscopic washout and reduction. The left lower limb was shortened and wasted with limited hip movements. He had recently travelled to Zambia, his country of origin. Imaging demonstrated a large mass with chronic erosions of the acetabulum and femoral head. Synovial biopsy grew Mycobacterium tuberculosis, which was treated with rifampicin, isoniazid, pyrazinamide, and ethambutol for 2 months then 4 months of rifampicin and isoniazid. Whole genome sequencing indicated full sensitivity. Complex reconstructive surgery is scheduled, with a custom femoral head and acetabulum. This case illustrates the importance of considering tuberculosis in patients with erosive joint pathology and a multidisciplinary approach as delayed diagnosis results in high morbidity. Prompt diagnosis using newer modalities such as whole genome sequencing on synovial fluid can enable timely treatment.