Imaging Findings of Hip Osteoarticular Tuberculosis: A Case Report

Abstract

Aims: To describe the clinical presentation and imaging features of a case of hip osteoarticular tuberculosis, and to highlight the contribution of imaging to its diagnosis and management. Presentation of Case: We report the case of a 77-year-old patient presenting with progressive hip pain evolving over two months without fever. Initial radiography showed joint space narrowing and soft-tissue infiltration. MRI revealed synovitis associated with advanced destructive joint changes. Further evaluation with abdominal CT demonstrated necrotic intra- and retroperitoneal lymphadenopathy and extension of a hip abscess into the psoas muscle, suggesting tuberculous osteoarticular disease. The C-reactive protein level was raised at 50 mg/L, and testing for human immunodeficiency virus was negative. The diagnosis was confirmed by Xpert MTB/RIF (GeneXpert) analysis of pus obtained at surgical drainage, which detected Mycobacterium tuberculosis complex with no rifampicin resistance detected. The patient was treated with antituberculous therapy and image-guided drainage of associated collections. Discussion: This case illustrates the diagnostic difficulty of hip tuberculosis, whose insidious clinical presentation and nonspecific imaging findings may mimic pyogenic arthritis or other destructive joint diseases. Multimodal imaging, particularly MRI, was central to demonstrating the extent of joint and soft-tissue involvement and to guiding percutaneous drainage, while microbiological confirmation by GeneXpert remained necessary to establish the diagnosis with certainty. Conclusion: Hip tuberculosis often presents with insidious symptoms and may mimic other infectious or inflammatory joint diseases. Imaging, particularly MRI, plays a key role in delineating the extent of joint and soft-tissue involvement and guiding management, but the imaging findings are suggestive rather than diagnostic and microbiological confirmation remains mandatory. Early diagnosis and prompt treatment are essential to prevent irreversible joint damage.