Isolated cystic tuberculosis of medial cuneiform: a case report

Nadeem Ali, Abedullah Bhat, Khalid Muzzafar, Akeela Fatima

Abstract


Isolated tuberculosis of foot is a rare entity. Plenty of literature is available on osteoarticular tuberculosis but literature on tuberculosis of foot is limited. Additionally the condition mimics variety of other foot pathologies which can delay diagnosis and add to morbidity. We present a twelve year old boy who presented clinically with swelling, pain and discharging sinus of foot with a cystic lesion in medial cuneiform on radiography. Though histopathology and Ziehl Nielsen staining later on established the diagnosis, but initially it was mistaken as a case of mycotic osteomyelitis. Tuberculosis of foot, though rare, should always be one of the differential diagnoses in a patient presenting with bony lesion on radiography irrespective of absence of constitutional symptoms and negative tests for tuberculosis. If battery of tests fails to establish diagnosis, open biopsy with curettage and histopathology should be considered to work out the final diagnosis.


Keywords


Cuneiform, Cystic tubercular osteomyelitis, Mycotic osteomyelitis, Tuberculosis

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References


Martini M, Adjrad A. Tuberculosis of the ankle and foot joint. In: Martini M, ed. Tuberculosis of the bones and joint. Berlin: Springer Verlag, 1988.

Dhillon MS, Sharma S, Gill SS, Nagi ON. Tuberculosis of bones and joints of the foot: an analysis of 22 cases. Foot Ankle 1993;14:505-13.

Dhillon MS, Aggarwal S, Prabhakar S, Bachhal V. Tuberculosis of the foot: An osteolytic variety. Indian J Orthop 2012;46:206-11.

Watts HG, Lifeso RM. Current Concepts Review - Tuberculosis of Bones and Joints. J Bone Joint Surg Am 1996;78:228.

Tuli SM. Tuberculosis of the skeletal system (bones, joints, spine and bursal sheaths). Second ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd, 1991:3-122.

Dhillon M S, Nagi ON. Tuberculosis of the foot and ankle. Clin Orthop Relat Res 2002 May;398:107-13.

Sankaran B. Tuberculosis of bones and joints. Ind J Tub 1993;40:109-18.

Dhillon MS, Tuli SM. Osteoarticular tuberculosis of the foot and ankle. Foot Ankle Int 2001;22:679-86.

Sharma NL, Mahajan VK, Agarwal S, et al. Nocardial mycetoma: diverse clinical presentations. Indian J Dermatol Venereol Leprol 2008;74(6):635-40.

Mittal R, Gupta V, Rastogi S. Tuberculosis of the foot. J Bone Joint Surg 1999;81:997-1000.

Kline A. Aneurysmal Bone Cyst of the Middle Cuneiform: A case report. Foot Ankle J 2008;1(6):2.

Evanchick CC, Davis DE, Harrington TM. Tuberculosis of peripheral joints: an often missed diagnosis. J Rheumatol 1986;13:187-9.

Hsu SH, Sun JS, Chen IH, Liu TK. Reappraisal of skeletal tuberculosis: role of radiological imaging. J Formos Med Assoc 1993;92:34-41.

Mousa HA. Bones and Joints Tuberculosis. Bahrain Med Bull 2007;29(10).1-9.