{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:34:49Z","timestamp":1753893289458,"version":"3.41.2"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>This article reports and analyzes a case of postoperative tuberculosis infection in an 80-year-old female after total hip arthroplasty, which was misdiagnosed and mistreated due to imaging findings resembling a pseudo-bursa cyst. The patient had a history of right femoral neck fracture, underwent right total hip arthroplasty 4 years ago, and developed a lump on the posterior side of the right thigh 1 year ago. Initial MRI at another hospital diagnosed it as a pseudo-bursa cyst and underwent excision surgery, but recurred 2 months later. Upon admission, repeated fluid aspiration, biochemical analysis of the fluid (showing high protein, high specific gravity, and positive Rivalta test), PPD, and T-SPOT.TB tests all indicated active tuberculosis infection. Cheese-like necrosis and granuloma formation were found during surgery, confirming postoperative tuberculosis infection. The patient underwent local debridement surgery combined with 9 months of standard HRZE anti-tuberculosis treatment (isoniazid, rifampicin, pyrazinamide, and ethambutol). Follow-up at 9 months showed the lump had disappeared, inflammatory markers returned to normal, and the prosthetic joint remained stable with improved joint function. This case highlights the challenge of tuberculosis infection being masked by common postoperative complications, emphasizing the importance of multidimensional examination and comprehensive diagnosis of diseased tissues to reduce misdiagnosis rates, improve treatment success rates, and enhance patient quality of life.<\/jats:p>","DOI":"10.3389\/fsurg.2025.1612055","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T04:12:44Z","timestamp":1748319164000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Misdiagnosis of tuberculous infection as pseudo-bursa cyst after total hip arthroplasty: a case report"],"prefix":"10.3389","volume":"12","author":[{"given":"Zhen","family":"Jia","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhengqi","family":"Chang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiyong","family":"Wan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"636","DOI":"10.5312\/wjo.v6.i8.636","article-title":"Total hip replacement for arthritis following tuberculosis of hip","volume":"6","author":"Kumar","year":"2015","journal-title":"World J Orthop"},{"key":"B2","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1007\/s00508-008-1006-5","article-title":"Reactivation of tuberculosis after total hip replacement\u201458 years after primary infection","volume":"120","author":"Maricevic","year":"2008","journal-title":"Wien Klin Wochenschr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"849","DOI":"10.3390\/microorganisms12050849","article-title":"Prosthetic joint infections caused by Mycobacterium tuberculosis complex-an ESGIAI-ESGMYC multicenter, retrospective study and literature review","volume":"12","author":"Au\u00f1on","year":"2024","journal-title":"Microorganisms"},{"key":"B4","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.jinf.2018.08.008","article-title":"Mycobacterium tuberculosis prosthetic joint infections: a case series and literature review","volume":"78","author":"Uhel","year":"2019","journal-title":"J Infect"},{"key":"B5","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.jcot.2017.09.013","article-title":"Total hip replacement in tuberculosis of hip: a systematic review","volume":"9","author":"Tiwari","year":"2018","journal-title":"J Clin Orthop Trauma"},{"key":"B6","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1080\/000164701753542104","article-title":"Active tuberculosis of the hip treated with early total hip replacement\u2013a report of 3 cases","volume":"72","author":"Yoon","year":"2001","journal-title":"Acta Orthop Scand"},{"key":"B7","doi-asserted-by":"publisher","first-page":"35","DOI":"10.18502\/jost.v10i1.14969","article-title":"Total hip arthroplasty in an old man with acetabular protrusion due to active Tuberculosis infection: a case report","volume":"10","author":"Zandi","year":"2024","journal-title":"J Orthop Spine Trauma"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e65110","DOI":"10.7759\/cureus.65110","article-title":"Management of Tuberculosis of the hip with antitubercular therapy and single-stage total hip replacement: a case report","volume":"16","author":"Singh","year":"2024","journal-title":"Cureus"},{"key":"B9","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1186\/s12891-024-08053-1","article-title":"Total hip arthroplasty in hip tuberculosis: a systematic review","volume":"26","author":"Zheng","year":"2025","journal-title":"BMC Musculoskelet Disord"},{"key":"B10","doi-asserted-by":"publisher","first-page":"101410","DOI":"10.1016\/j.arr.2021.101410","article-title":"Targeting immune dysfunction in aging","volume":"70","author":"Borgoni","year":"2021","journal-title":"Ageing Res Rev"},{"key":"B11","doi-asserted-by":"publisher","first-page":"636","DOI":"10.5588\/ijtld.12.0811","article-title":"Diagnostic and prognostic value of serum C-reactive protein for screening for HIV-associated tuberculosis","volume":"17","author":"Lawn","year":"2013","journal-title":"Int J Tuberc Lung Dis"},{"key":"B12","doi-asserted-by":"publisher","first-page":"34","DOI":"10.32807\/jambs.v7i1.169","article-title":"Hubungan antara kadar laju endap darah (LED) dengan kadar C-reaktiv protein (CRP) pada penderita tuberkulosis (TBC) di wilayah kerja puskesmas alas barat","volume":"7","author":"Nurmawan","year":"2020","journal-title":"J Anal Medika Biosains"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1900","DOI":"10.1111\/os.12852","article-title":"Total knee arthroplasty in patients with unsuspected Tuberculosis of the joint: a report of four cases and a systematic review of the literature","volume":"12","author":"Wang","year":"2020","journal-title":"Orthop Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.7507\/1002-1892.201807033","article-title":"Effectiveness of total hip arthroplasty for hip infection sequelae","volume":"32","author":"Zhang","year":"2018","journal-title":"Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi"},{"key":"B15","doi-asserted-by":"publisher","first-page":"303","DOI":"10.22271\/ortho.2023.v9.i2d.3384","article-title":"Total hip replacement in tuberculosis of hip: a retrospective and prospective study","volume":"9","author":"Ahmed","year":"2023","journal-title":"Int J Orthop Sci"},{"key":"B16","doi-asserted-by":"publisher","first-page":"183","DOI":"10.21203\/rs.3.rs-415383\/v1","article-title":"Hip tuberculosis at stage IV: outcomes and some conditions for total hip replacement","volume":"12","author":"Dang","year":"2021","journal-title":"Open J Orthop"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1612055\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T04:12:47Z","timestamp":1748319167000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1612055\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,27]]},"references-count":16,"alternative-id":["10.3389\/fsurg.2025.1612055"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2025.1612055","relation":{},"ISSN":["2296-875X"],"issn-type":[{"type":"electronic","value":"2296-875X"}],"subject":[],"published":{"date-parts":[[2025,5,27]]},"article-number":"1612055"}}