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Synovial tissue analysis yielded a positive acid-fast bacillus smear and <jats:italic>Mycobacterium tuberculosis<\/jats:italic> PCR test, while aerobic culture studies grew <jats:italic>Pseudomonas aeruginosa<\/jats:italic> and <jats:italic>Acinetobacter baumannii<\/jats:italic>. Chronic granulomatous inflammation was seen on histopathology. Alongside antibiotic therapy, multiple debridements of the right knee were required to eradicate the infection and allow wound repair. A flap coverage with split-thickness skin graft was performed after the bacterial infection resolved, and the patient was discharged ambulatory with minimal pain. Such atypical presentations of monarthritis require immediate workup and a prompt referral to a multidisciplinary team to establish the diagnosis and initiate appropriate management before irreversible joint destruction and disability ensues.<\/jats:p>","DOI":"10.1136\/bcr-2021-245583","type":"journal-article","created":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T13:27:53Z","timestamp":1635859673000},"page":"e245583","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Great imitator: an unusual presentation of osteoarticular tuberculosis of the knee with gram-negative bacterial arthritis"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7239-3382","authenticated-orcid":false,"given":"Patricia Pauline","family":"Remalante-Rayco","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8235-0968","authenticated-orcid":false,"given":"Patricio III Espinoza","family":"Dumlao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University of the Philippines - Philippine General Hospital, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1152-331X","authenticated-orcid":false,"given":"Angeline-Therese","family":"Santiago","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,11,2]]},"reference":[{"key":"2025082711284425000_14.11.e245583.1","first-page":"2189","article-title":"Osteoarticular tuberculosis-a three years' retrospective study","volume":"7","author":"Arathi","year":"2013","journal-title":"J Clin Diagn Res"},{"key":"2025082711284425000_14.11.e245583.2","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.mpmed.2013.10.008","article-title":"Extrapulmonary tuberculosis","volume":"42","author":"Houston","year":"2014","journal-title":"Medicine"},{"key":"2025082711284425000_14.11.e245583.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.medmal.2009.03.004"},{"key":"2025082711284425000_14.11.e245583.4","first-page":"822","article-title":"Poncet's disease (tuberculous rheumatism): two case reports and review of the literature","volume":"9","author":"Ozgul","year":"2005","journal-title":"Int J Tuberc Lung Dis"},{"key":"2025082711284425000_14.11.e245583.5","unstructured":"Marquez J , Espinoza LR . 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