IJSR - International Journal of Scientific Research

Dr. Jose Austine; Dr. Atmananda Hegde; Dr. Kiyana Mirza

Volume : VIII, Issue : VIII, August - 2019

A rare, unusual case of isolated tuberculous osteomyelitis of the cuneiform bone– A case report

Dr. Jose Austine, Dr. Atmananda Hegde, Dr. Kiyana Mirza

Abstract :

Introduction: A mere 1 in 1000 cases of TB involve the bones of the foot. The diagnosis of tuberculosis involving bones of the foot continues to challenge doctors to arrive at timely conclusions especially when the condition presents as a single–bone disease, spå the joint. The situation becomes more complex with lack of contributory clinical and haematological features that usually aid in diagnosing TB. Case report: We report on a 36–year–old lady who presented with pain and a chronic non–healing ulcer over the dorso–medial aspect of the left foot of 4 months duration. Guided by initial radiographs and based on an MRI a diagnosis of osteomyelitis of the medial cuneiform, not specifically tuberculous, was made. Our patient underwent deidement, curettage and excision of the sinus. Bone tissue was sent for biopsy and vancomycin powder was placed in situ. The final diagnosis of tuberculous osteomyelitis was established post–operatively following histopathological examination of biopsy. The patient then received ATT for 12 months. Discussion: Tuberculosis can mimic a wide spectrum of diseases and the condition is often misdiagnosed or the diagnosis delayed as seen in our case, due to their rarity and lack of clinician familiarity. Their recognition is of practical and economic importance. Tuberculous osteomyelitis must be considered when a patient presents with a chronic non–healing ulcer or sinus over the foot especially in an endemic country like India. It should also be kept in mind if there is a bony lesion with poorly defined edges and surrounding sclerosis. Early diagnoses and timely intervention can prevent complications and will allow most cases to be treated conservatively. Conclusion: A high index of suspicion as well as awareness among orthopaedists and general practitioners is therefore warranted for early diagnosis and decreasing morbidity