Abstract:
Introduction and importance: Skeletal TB is an uncommon
accounting for 10% of extra-pulmonary TB (1). The
symptoms of musculoskeletal TB may present slowly over an extended
period of time, making a diagnosis difficult and time-consuming(2). For the best possible outcome and to reduce the
risk of deformity diagnosis must be early (1). For the
treatment of drug-susceptible musculoskeletal illness, a rifampin-based
regimen lasting 12 months is advised. (9–11)
Case presentation: A 33-year-old female who are working as nurse
with ankle pain and swelling over a period of 2 months. She had history
of partially treated pulmonary TB one year ago. She reported night
sweats and low-grade fever during this period, and she denied any
history of trauma.
Clinical findings and investigations: The right ankle was
globally swollen and tender anteriorly and on the lateral malleolus. The
skin over the ankle showed dark discoloration with cautery marks with no
discharging sinuses. The range of motion of the right ankle was
decreased. The plain
X-ray of the right ankle showed three cystic lesion at the distal tibia,
one cyst at the lateral malleolus and another one at the calcaneum.
Surgical biopsy and Expert gene test confirmed the diagnosis of
tuberculous osteomyelitis.
Interventions and outcome: The patient was planned for surgical
curettage of the lesion. After the confirmation of the diagnosis of TB
with the biopsy and gene expert test, with consultation of senior chest
physician the patient fitted to anti-tuberculous regimen. The patient
had good functional and clinical outcome.
Conclusions: skeletal TB is overall rare and even TB of the foot
and ankle TB is rarest. The diagnosis of foot and ankle TB is
challenging due to unusual presentation and the variety of foot
pathologies which can mimic the TB with its varied spectrum of clinical
and radiological presentations, which frequently misleads the treating
clinician. High index of suspicion is needed in order to establish an
early diagnosis and to early start of anti-tuberculous therapy to
minimize the complications if not full recovery of the patient.
Relevance and impact: The lesson behind this case is that the
diagnosis TB osteomyelitis should be on the top of differential
diagnosis of multiple cystic lesions around the foot and ankle
especially in area where TB is endemic. Early diagnosis and early start
of anti-tuberculous therapy can lead to full cure of the patient and in
bad situation can minimize the complications.