A 21-year-old male from Buenos Aires with a history of vertically transmitted HIV infection and abandonment of several highly active antiretroviral treatments (HAART).
He was admitted for a febrile syndrome of three weeks of evolution, associated with cough and weight loss of approximately 10 kg.
On physical examination the patient was in regular general condition and feverish skin and mucous membranes.
A painless hepatomegaly was diagnosed and pulmonary auscultation revealed a generalized decrease in pulmonary murmur in both lung fields.
The chest X-ray showed a parahilar and basal right opacity with a pneumonic appearance.
Laboratory test results at admission were as follows: enter sedimentation > 140 mm 1 hour, haematocrit 21%, target hemoglobin 6.6 g/L, leukocytes 4.400 cells/ mm3, alkaline urea breath / mm3, platelets 40,000 c
CD4 T lymphocyte count was 21 cells/mm3 (8%).
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expectoration samples were taken for identification of current growth bacteria, mycobacteria and fungicides.
Direct examination using the Zielh-Neelsen technique revealed 10 bacilli resistant acid (BAAR) per 10 fields.
The abdominal ecotomography confirmed the existence of hepatomegaly and multiple hypoechogenic adenopathies in the retroperitoneum, in relation to the inferior vena cava and the hepatoduodenal ligament.
Hypoechogenic images were also observed in the spleen, mesentery and retroperitoneum.
With the diagnosis of probable tuberculosis, treatment was initiated with isoniazid, rifampin, pyrazinamide and etambucil as usual daily doses.
One week after starting therapy, the patient began to complain of pain in the left hip joint radiating to the thigh, causing functional impotence and pain in semiflexion.
The patient presented pain due to palpation of the hip joint, with impossibility of active and passive extension of the left lower limb.
The echotomography showed a moderate amount of articular fluid and in the computerized axial tomography (CAT) it was observed a radiolucent image, rounded, in the union of the head and the femoral neck, with cortical solution.
The acetabular cavity and femoral head were respected, as well as the pubic symphysis and the ischial and iliopubial branches.
A moderate volume of fluid was observed in the articular cavity.
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An arthrocentesis was performed obtaining a sero-hepatite material.
Samples were sent for identification of common growth bacteria, mycobacteria and isolation.
Direct examination using the Zielh-Neelsen technique showed five to nine AFB per 100 observation fields.
In addition to anti-tuberculous treatment, analgesics and corticosteroids were added.
Seven days later, the patient presented a favorable evolution, with paulatin recovery of mobility of the left lower limb, supported by kin support.
Cultures of sputum and joint fluid samples allowed the identification of Mycobacterium tuberculosis with preserved susceptibility to the drugs prescribed.
After 30 days of treatment there was a marked improvement in lung lesions and direct examination of expectoration control was negative for AFB.
