Tuberculous arthritis mimic arthritis of the Sjögren's syndrome: findings from sonography, computed tomography and magnetic resonance images

Abstract 

A patient with a history of Sjögren's syndrome developed chronic arthritis of left ankle. It was diagnosed as arthritis of the Sjögren's syndrome initially. However, joint pain persisted despite corticosteroid therapy. Sonography disclosed a multiloculated cystic lesion with peripheral hyperechoic enhancement around left ankle and extended to Achilles tendon and subcutaneous region. Computed tomography (CT) confirmed the findings. Magnetic resonance imaging (MRI) revealed increased signal intensity of the lesion after gadonillium enhancement on T1-weighted images. These abnormalities showed inhomogenous high signal intensities on T2-weighted images. Tuberculous arthritis was diagnosed by positive synovial tuberculous culture. Sonography is a valuable tool that offers significant advantages for the initial evaluation of arthritis of the Sjögren's syndrome and help early suspicious of tuberculous arthritis, because of its cost-effectiveness, superior differentiation between the cyst and solid lesions, convenience for guiding biopsy and drainage.

Keywords:  Tuberculous arthritis, Sonography, Computed tomography, Magnetic resonance, Sjögren's syndrome