Navigating diagnostic uncertainty: A case report of concurrent osteoarticular tuberculosis and miliary mottling in chest imaging

Extra-pulmonary tuberculosis, including musculoskeletal tuberculosis presents diagnostic challenges due to diverse clinical manifestations. We present a case of a postpartum woman from Sri Lanka who initially presented with knee joint pain and subsequently developed respiratory symptoms. Her chest X-ray revealed miliary mottling, prompting further investigation. Despite sputum negative for acid-fast bacilli (AFB), the knee joint biopsy confirmed tuberculosis of joint. The diagnostic dilemma persisted regarding whether the presentation represented isolated osteoarticular tuberculosis or concurrent miliary tuberculosis.This case highlights the complexity of diagnosing extra-pulmonary tuberculosis and the need for vigilance in evaluating diverse clinical presentations related to tuberculosis.