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Infectious Diseases and Tuberculosis · Journal article
American Journal of Tropical Medicine and Hygiene · August 11, 2026
Early or partial results. Treat as a signal, not a conclusion.
This case report describes successful diagnosis of culture-negative tuberculous arthritis of the knee using metagenomic next-generation sequencing (mNGS) in a 70-year-old patient after standard microbiology had failed and a 4-year diagnostic delay. The patient achieved clinical remission with antituberculous therapy, suggesting mNGS may have diagnostic utility in paucibacillary extrapulmonary tuberculosis, but the evidence remains anecdotal and does not yet support clinical practice change.
Case report. A 70-year-old man presenting with 2-year history of left knee pain and recurrent swelling, comorbid lung cancer, undergoing antituberculous therapy. Intervention: Metagenomic next-generation sequencing (mNGS) of joint fluid; triple-antituberculous therapy for 1 year. n = 1.
70-year-old man with 2-year history of left knee pain and recurrent swelling Repeated standard tuberculosis tests were negative before mNGS identified Mycobacterium tuberculosis Diagnosis made nearly 2 years after initial presentation
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
This case illustrates that mNGS may enable diagnosis of culture-negative tuberculous arthritis when conventional microbiology fails, particularly in immunocompromised or elderly patients with nonspecific chronic joint symptoms. However, a single case does not establish the diagnostic accuracy, cost-effectiveness, or clinical utility of mNGS compared to alternative diagnostic strategies, and prospective validation is required before routine adoption.
A single case report describing successful diagnostic use of metagenomic sequencing in culture-negative tuberculous arthritis, with clinical resolution after treatment, but lacking comparative data, control arm, or prospective validation.
As stated by the source record.
Quoted from the source exactly as published.
This case illustrates that mNGS may enable diagnosis of culture-negative tuberculous arthritis when conventional microbiology fails, particularly in immunocompromised or elderly patients with nonspecific chronic joint symptoms. However, a single case does not establish the diagnostic accuracy, cost-effectiveness, or clinical utility of mNGS compared to alternative diagnostic strategies, and prospective validation is required before routine adoption.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
ABSTRACT. Tuberculous arthritis of the knee is a rare form of extrapulmonary tuberculosis that often presents with nonspecific symptoms, leading to delayed or missed diagnosis, particularly in elderly patients with comorbidities. We report the case of a 70-year-old man with a 2-year history of left knee pain and recurrent swelling. The patient was under therapy for lung cancer. He underwent two arthroscopic procedures for both diagnostic and therapeutic purposes. Repeated standard tests for tuberculosis were negative before metagenomic next-generation sequencing (mNGS) identified Mycobacterium tuberculosis nearly 2 years later. After 1-year triple-antituberculous therapy, he remained asymptomatic at the 2-year follow-up. This case highlights a high index of suspicion for indolent infection in culture-negative chronic arthropathy. The use of mNGS—increasingly accessible and cost effective—enables rapid and sensitive diagnosis of paucibacillary extrapulmonary tuberculosis.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.