Tuberculosis of the Elbow in a Chronic Kidney Disease Patient with Arteriovenous Fistula: A Case Report.

INTRODUCTION: Tuberculosis (TB) involving the elbow joint is an uncommon form of osteoarticular infection and often presents with non-specific symptoms, leading to delayed diagnosis and treatment. The condition may mimic other chronic inflammatory or infective arthropathies, posing significant diagnostic challenges. In patients with chronic kidney disease (CKD) undergoing hemodialysis, the presence of an arteriovenous (AV) fistula in the affected limb further complicates both clinical evaluation and surgical management. Reports describing TB of the elbow in the setting of CKD with an ipsilateral AV fistula are extremely limited, making this case clinically significant and relevant to orthopedic practice.

CASE REPORT: A 75-year-old gentleman of South Indian origin presented with pain, swelling, and restricted movements of the left elbow of 2 weeks duration, associated with intermittent low-grade fever. He was a known case of CKD on maintenance hemodialysis through an AV fistula in the same limb. Clinical examination revealed diffuse swelling, warmth, and tenderness around the elbow joint with restricted range of motion. Radiographs were unremarkable, while magnetic resonance imaging suggested joint effusion with surrounding soft-tissue involvement. The patient underwent surgical drainage and curettage following pre-operative optimization of the kidney function. Microbiological molecular testing confirmed TB with resistance to rifampicin, while histopathology showed features of chronic inflammation. The patient showed clinical improvement following surgical intervention and initiation of appropriate medical therapy.

CONCLUSION: This case highlights the importance of maintaining a high index of suspicion for TB in atypical presentations of elbow joint pathology, especially in immunocompromised individuals. The coexistence of CKD and an AV fistula presents unique diagnostic and therapeutic challenges, requiring a multidisciplinary approach. Early recognition and combined clinical, radiological, and laboratory evaluation are essential to prevent joint destruction and functional disability. This report contributes to orthopedic literature by emphasizing a rare clinical scenario and underscores the need for individualized management strategies in complex patients, thereby enhancing understanding of disease presentation and optimizing treatment outcomes.