An 83-year-old male without toxic habits, with a history of osteoporosis, left elbow fracture and right arm 12 years earlier, as well as a prostatectomy and inguinal herniorrhaphy who consulted due to a chronic ankle synovitis plus cold treatment did not present local discomfort.
Previously he had been evaluated with a chest X-ray, complete blood count and basic biochemistry that was normal, as well as an ankle arthrocentesis that showed no crystals and only inflammatory component, with cultures in normal negative media.
Rheumatoid factor, antinuclear antibodies, acid and analytical multiparametric tests as well as SACE, HIV, serology B, C, loes, lyme and brucela were normal or negative.
Physical examination was normal except for left ankle synovitis.
The left ankle X-ray showed patchy distribution with loss of joint space and bone erosions.
A chest X-ray was repeated, which showed right apical infiltrate not evidenced in the previous X-ray. Mantoux was performed, which was positive and a new arthrocentesis was performed. 90% showed no crystals and was clearly inflammatory 25600 mg.
Cultures were negative in normal media.
BK negative.
Lowenstein culture positive for M. tuberculosis.
Since the patient did not expectorate, bronchoscopy showed normal macroscopic results, negative cytology for malignancy and negative bronchial aspirates for BK and positive Lowenstein culture M. tuberculosis.
The diagnosis of tuberculous synovitis of the left ankle and pulmonary tuberculosis was made.
The patient started treatment with Rifater with favorable evolution.
