Case Report: Diagnosis of Extrapulmonary Manifestation of Tuberculosis in Knee Bones/Joints by Using Radiopharmaceutical 99mTc-Ethambutol and Side Effects Monitoring

Introduction: Tuberculosis (TB) is an infectious disease caused by Mycobacterium Tuberculosis (M.TB). M.TB can infect lung parenchyma and other body organs (extrapulmonary), such as knees/joints. Indonesia is a country with the second largest number of TB cases in the world. The problem of TB diagnosis methods, especially in detecting extrapulmonary M.TB with a higher accuracy, is a serious concern for all parties. This research aims to diagnose extrapulmonary TB in the knee bones/joints by using the radiopharmaceutical 99mTc-ethambutol and monitor side effects. Case description: Nuclear medicine procedures are used to conduct medical procedures on several subjects (ethambutol examination). The radiopharmaceutical 99mTc-ethambutol was injected intravenously into the body, and then imaging was performed using a gamma camera. The imaging results are visualized by observation of the capture of radioactivity in the knee bone/joint organs infected with M.TB. We found 3 exciting cases of subjects suffering from extrapulmonary TB disease of the knee bones/joints in a series of post-marketing surveillance studies. In case 1, the ethambutol examination diagnosed M.TB in the genu sinistra projection. In case 2, ethambutol examination diagnosed M.TB in the lungs and extrapulmonary simultaneously, infection in the left lung, and genu dextra. In case 3, ethambutol examination diagnosed M.TB in the left bilateral genu. The results of side effects monitoring using the radiopharmaceutical 99mTc-ethambutol indicated no changes in blood hematology examination, peripheral blood hematology, or complaints in the three subjects, both before and after the ethambutol examination. This indicates no side effects before and after administering the radiopharmaceutical 99mTc-ethambutol. Conclusion: This report presents three cases with suspected pulmonary and/or extrapulmonary TB in the knees/joints, which was detected by nuclear medicine methods using the radiopharmaceutical 99mTc-ethambutol. Different side effects are carried out through a complete blood laboratory examination and monitoring complaints of each patient.