Total elbow arthroplasty for active primary tuberculosis of the elbow: a curious case of misdiagnosis

The incidence of musculoskeletal tuberculosis (TB) is on the rise due to the current Acquired Immunodeficiency Syndrome (AIDS) pan-demic. Spine is the most common osseous site, followed by other joints. TB identified in the elbow accounts for 2%–5% of skeletal TB cases, which are secondary to pulmonary TB. Primary elbow TB is rare. We report a case of primary TB of the elbow which had a negative syno- vial biopsy. A 46-year-old right-hand dominant female patient with chronic pain and disability of the right elbow was diagnosed with chronic non-specific arthritis based on an arthroscopic synovial biopsy. The case was diagnosed retrospectively as active TB from bone cuts
post total elbow arthroplasty. Anti-tuberculosis treatment (ATT) was given postoperatively for 12 months. The patient reported good func- tional outcomes at 3 years of follow-up. Such atypical presentations of osteoarticular TB are challenging to diagnose. Therefore, particularly in endemic areas, clinicians should be careful before excluding such a diagnosis even after a negative biopsy. Further research should inves-tigate whether active TB of small joints such as the elbow can be treated with ATT, and early arthroplasty should be a focus of this research.