Tuberculous arthritis of the elbow in a hemodialyzed patient

Recently, bone cystic radiolucency has become familiar as a complication in long-term dialysis patients. It is mainly caused by dialysis amyloidosis and rarely by infectious involvement of the appendicular skeleton. Here we present a hemodialysis patient with tuberculous arthritis of the elbow. A 56-year-old male with end-stage renal failure due to chronic glomerulone phritis had been treated by hemodialysis for 12 years. He first developed left elbow joint pain and swelling in June, 1988. The aspirated elbow joint fluid proved sterile on culture. Radiographs showed extensive cystic lesions of the trochlear eminence of the humerus thought to be due to dialysis amyloidosis. The lesion was partially filled by fibrous tissue, curetted thoroughly and an iliac crest graft was added. Histological examination revealed granulomas consisting of central necrosis, epithelioid cells and multinucleated giant cells of the Langhans type. No amyloid deposits were detected. Cultures of the joint fluid revealed Mycobacterium tuberculosis. Antitubercular drugs were given postoperatively. Convalescence was uneventful. Tuberculosis of the elbow in hemodialysis patient has not been reported previously. It is important to differentiate dialysis amyloidosis from tuberculous arthritis, because both show similar radiographic findings.