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.