Case 4

Notice he swelling of her right shoulder

A 60 years old woman had been suffering from chronic pain and swelling of the right shoulder for two years. She had no fever and no history of weight loss. She had no prior medical problems. The examination revealed markedly swollen right shoulder, limited range of motion and mild tenderness. Synovial biopsy was done and Mycobacterium tuberculosis was found in the culture. Tuberculous arthritis of right shoulder was diagnosed. To my horror, she had never had a chest x-ray despite her frequent visit to the Orthopedics OPD!  She was later treated with oral anti-TB drugs.