# Tuberculosis Presenting as Migratory Arthritis: A Case Report from Iraq

## TL;DR

A 66-year-old man with diabetes was misdiagnosed with rheumatoid arthritis but later found to have tuberculosis causing migratory arthritis, highlighting the importance of considering infections in similar cases.

## Contribution

This case report highlights tuberculosis as an underrecognized cause of migratory arthritis in immunocompetent individuals.

## Key findings

- Tuberculosis can present as migratory arthritis without pulmonary symptoms, leading to misdiagnosis.
- Antituberculous therapy resolved arthritis and improved clinical outcomes within weeks.
- Infectious etiologies should be considered before immunosuppressive treatment in treatment-resistant arthritis.

## Abstract

Extrapulmonary tuberculosis is uncommon, and musculoskeletal involvement presenting as migratory arthritis is particularly rare in immunocompetent individuals, often leading to misdiagnosis and delayed treatment. We report the case of a 66‐year‐old man with diabetes mellitus who presented with recurrent migratory inflammatory arthritis affecting multiple joints over 1 year, without initial pulmonary symptoms. He was initially diagnosed with rheumatoid arthritis based on positive rheumatoid factor and elevated inflammatory markers and was treated with disease‐modifying antirheumatic drugs without clinical improvement. At presentation, he reported severe shoulder pain, morning stiffness, weight loss, and night sweats. Imaging revealed right upper lobe consolidation and a metabolically active cavitary lung lesion on PET‐CT. Bronchoalveolar lavage culture confirmed
Mycobacterium tuberculosis
. Antituberculous therapy was initiated, resulting in marked clinical improvement and resolution of arthritis within weeks. This case highlights tuberculosis as an important, underrecognized cause of migratory arthritis and emphasizes the need to consider infectious etiologies in treatment‐resistant inflammatory joint disease, particularly in endemic regions.

Tuberculosis should be considered in patients with treatment‐resistant inflammatory arthritis or rheumatoid arthritis–like presentations, particularly when constitutional symptoms are present or in endemic settings. Infectious etiologies must be excluded before initiating or escalating immunosuppressive therapy. Early recognition of atypical extrapulmonary tuberculosis can prevent misdiagnosis, inappropriate immunosuppression, and delay in definitive treatment.