Thorn induced culture negative synovitis: could be a case of tuberculosis? Polymerase chain reaction is an important diagnostic tool

Upadhyay Sachin; Thakur Dileep Singh

Volume : VI, Issue : III, March - 2016

Thorn induced culture negative synovitis: could be a case of tuberculosis? Polymerase chain reaction is an important diagnostic tool

Upadhyay Sachin, Thakur Dileep Singh

Abstract :

Background: Thorn induced synovitis is an uncommon cause of monoarthritis and often misdiagnosed or overlooked. Symptoms may be vague and can mimic other conditions. If not investigate properly the condition can be disabling and cause marked joint destruction. Material and method: Fives cases of thorn induced synovitis were identified. Three of whom were men. Mean age was 28.6 years (range, 15 to 42 years). In all the present cases the site of injury was on the knee joints. Symptoms included pain, swelling, effusion and stiffness. Clinical examination showed synovitis with decreased range of movements of knee joint. There was considerable delay in the diagnosis, averaging 16.2 weeks. All were investigated. Joint aspirate sent for routine microscopy and PCR (polymerase chain reaction) analysis. Treatment consists of Synovectomy with removal of the foreign body. Specimen sent for histopathological examination. Anti–tubercular drugs (DOTS; Category I) was administrated. All the cases were followed up for 12 months to check for relapse. Results: Three of five cases showed neutrophilic leucocytosis, raised ESR and anemia. Radiographs of knee showed no bony involvement. Ultrasonography (USG) of knee joint revealed effusion and loculated collection with small foreign body in suprapatellar region. Synovial fluid aspirated was found to be aseptic. Histopathological examination of the synovium showed chronic non suppurative synovitis with evidence of retained thorn in all except one patient. PCR of the joint aspirated showed the presence of Mycobacterium tuberculosis complex. Management comprises of Synovectomy, removal of the foreign body and anti–tubercular drugs. All patients showed uneventful recovery. Conclusion: All joint aspirates should be sent for PCR examination in patients with thorn–induced synovitis. We emphasize the need for prompt and early diagnosis. Optimal treatment is synovectomy, foreign body removal, and antitubercular drugs.