Great imitator: an unusual presentation of osteoarticular tuberculosis of the knee with gram-negative bacterial arthritis.

A 33-year-old man presented with a 2-year history of right knee swelling with fungating masses and white-yellow discharge. Severe pain, limited movement and signs of sepsis were absent. Debridement, partial synovectomy and arthrotomy were done for the multiple sinuses that developed over the knee. Synovial tissue analysis yielded a positive acid-fast bacillus smear and Mycobacterium tuberculosis PCR test, while aerobic culture studies grew Pseudomonas aeruginosa and Acinetobacter baumannii Chronic granulomatous inflammation was seen on histopathology. Alongside antibiotic therapy, multiple debridements of the right knee were required to eradicate the infection and allow wound repair. A flap coverage with split-thickness skin graft was performed after the bacterial infection resolved, and the patient was discharged ambulatory with minimal pain. Such atypical presentations of monarthritis require immediate workup and a prompt referral to a multidisciplinary team to establish the diagnosis and initiate appropriate management before irreversible joint destruction and disability ensues.

Takayasu Arteritis Presenting as Bilateral Ocular Ischemic Syndrome.

A 26-year-old female came in with progressive blurring of vision. She had developed memory loss and complained of headache, significant weight loss, and exertional left calf pain after prolonged walking. Pertinent physical findings included light perception on visual acuity examination, and the brachial and radial pulses of both arms were not appreciable. Thoracic and abdominal aortic imaging by computed tomography with contrast revealed narrowing along the thoracic aorta and its branches. Carotid Doppler showed bilaterally thickened walls in the common carotid arteries, with near total occlusion of the left carotid artery. These findings were consistent with bilateral ocular ischemic syndrome in Takayasu arteritis. She was given methylprednisolone 500 mg intravenously daily for 3 days with noted improvement in vision. She was discharged and showed improvement on prednisone 35 mg/day and aspirin 80 mg/day. On follow-up two weeks post-discharge, she reported being able to see silhouettes of persons and objects.