Caseous, necrotic material and epithelioid cell granulomas in synovial fluidfrom a patient with tuberculous infection:a case report.
BACKGROUND: The gross appearance and cytologic findings in synovial fluid intuberculous infections are similar to those in other types of chronic synovial effusion.Demonstration of acid-fast bacilli (AFB) is required for a definitive diagnosis of tuberculouseffusion; it is reported in only 20% of cases. The presence of frank caseous necrotic material andepithelioid cell granulomas in synovial fluid samples is unusual but strongly indicative oftuberculous infection. CASE: A 28-year-old man, on treatment for pulmonary tuberculosis, presentedwith a history of right ankle swelling, which was clinically interpreted as nonspecific synovitis.The synovial fluid was yellowish, with fluffy, whitish material. Cytologic smears showed abundant,caseous, necrotic material; a few histiocytic aggregates; and occasional epithelioid cellgranulomas. Although stain for AFB was negative, considering the clinical presentation, a diagnosisof tuberculous synovitis could be rendered. CONCLUSION: Caseous, necrotic material and epithelioidgranulomas in synovial fluid are highly unusual but, when present, can be considered definitiveevidence of tuberculous effusion, particularly in a known case of pulmonary tuberculosis.
Siddaraju,N　Bundele,MM
Department of Pathology, Jawaharlal Institute of Postgraduate MedicalEducation and Research, Pondicherry, India. rajusiddaraju@yahoo.com
Materials　 Synovial Fluid　 Cells Infection as complication of medical care
