Ankylosing spondylitis hip joint post mono-articular Tubercular arthritis: A clinical dilemma

Ankylosing spondylitis is a chronic inflammatory autoimmune disease of the axial skeleton, with variable involvement of peripheral joints and non-articular structures. Tuberculosis of hip and sacroiliac joints usually starts during first three decades but no age is immune. In early stages of TB of hip, there is a diagnostic dilemma when plain X-rays are negative. This case presents such a dilemma in the establishment of diagnosis and management protocol which was initiated elsewhere based on clinical assessment and incomplete as well as intermittent investigations. The idea of reporting this case is to emphasize on its rarity. The elsewhere treated one year old right tubercular hip was ultimately diagnosed as having ankylosing spondylitis affecting bilateral sacroiliac and hip joints with more advanced ankylosis in the left hip having an insidious onset and 10 degree of fixed flexion in left knee joint.