# Mycobacterium tuberculosis Complicating an Elective Right Total Knee Arthroplasty

## TL;DR

A rare case of tuberculosis infecting a prosthetic knee joint in a patient with no prior TB history is reported, highlighting the challenges in diagnosis and treatment.

## Contribution

This case emphasizes the importance of considering TB in culture-negative joint infections, especially when standard treatments fail.

## Key findings

- TB prosthetic joint infection was diagnosed using next-generation sequencing after routine cultures failed.
- The patient initially responded to standard TB therapy but later developed drug-resistant TB and multiorgan failure.
- The case underscores the need for high suspicion of TB in atypical joint infections.

## Abstract

Mycobacterium tuberculosis primarily causes pulmonary disease but can involve extrapulmonary sites, including bones and joints. Tuberculosis (TB) prosthetic joint infections (TB-PJIs) are rare, often diagnosed late due to low suspicion, indolent progression, and frequent culture negativity.

A 73-year-old man from Guyana underwent elective right total knee arthroplasty for osteoarthritis. Postoperatively, he developed a prosthetic joint infection without an identifiable pathogen by routine cultures. Advanced testing detected Mycobacterium tuberculosis complex via next-generation 16S rRNA gene sequencing. The patient initially improved with RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol) therapy but subsequently developed disseminated disease, raising concern for suspected drug-resistant TB. His hospital course was further complicated by bladder rupture and multiorgan failure, leading to death.

TB-PJIs may present without pulmonary symptoms or prior TB history and should be suspected in culture-negative joint infections, particularly when conventional therapy fails. Treatment may be further complicated by suspected multidrug resistance, as illustrated in this case.