A deceptive presentation of Tuberculosis hip as Staphylococcal infection, its successful management and literature review

BMJ Case Rep. 2018 Aug 23:2018:bcr2018224558. doi: 10.1136/bcr-2018-224558.


A 71-year-old man presented with septic arthritis of the hip with an initial culture growth of methicillin-sensitive Staphylococcus aureus (MSSA) masking the diagnosis of tuberculosis (TB). Based on joint aspirate culture and sensitivity results, the patient was first diagnosed with MSSA arthritis. He was started on intravenous antibiotics and underwent washout and debridement of hip. During the procedure, the surgeons observed characteristic tubercular changes and samples were sent for tubercular testing. The reports of cultures for acid-fast bacilli and synovial biopsies confirmed our intraoperative suspicion of TB. Antitubercular medication was started and it helped patient to improve quickly. He completed 9 months of tubercular treatment regimen and at completion total hip replacement was offered. At 8-year follow-up, the patient was doing fine with no recurrence of infection in his hip. High index of suspicion for skeletal TB was raised based on clinical and radiological signs especially if there was a delay or absence of response to appropriate therapy.

Keywords: Bone & Joint infection; septic arthritis; total hip arthroplasty; tuberculosis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Antitubercular Agents / therapeutic use*
  • Arthritis, Infectious / diagnosis*
  • Arthritis, Infectious / drug therapy
  • Arthritis, Infectious / surgery
  • Arthroplasty, Replacement, Hip / methods
  • Debridement / methods
  • Diagnosis, Differential
  • Hip Joint / pathology
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification
  • Staphylococcal Infections / diagnosis*
  • Tomography, X-Ray Computed
  • Tuberculosis, Osteoarticular / diagnosis*
  • Tuberculosis, Osteoarticular / drug therapy
  • Tuberculosis, Osteoarticular / surgery


  • Antitubercular Agents