Tuberculous Arthritis of the Ankle

Abstract

Tuberculosis (TB) is an infectious disease caused by the Mycobacterium tuberculosis complex (MTBC). Pulmonary TB is the most common form of presentation, but extrapulmonary tuberculosis (EPTB) contributes significantly to morbidity and mortality. Rarely, patients with EPTB develop a form of ankle or foot arthritis. The diagnosis of TB arthritis is often overlooked because of the insidious onset and the non-specific clinical symptoms. Prognosis is generally poor; early diagnosis and delivery of the most appropriate treatment is critical to avoid functional disability.

Learning points: Tuberculous arthritis of the ankle has high morbidity but often goes undiagnosed.Tuberculous arthritis of the ankle can lead to degenerative changes in the bone and articular cartilage and even to joint collapse.Timely diagnosis and correct treatment are important to avoid functional disability.

Keywords: Tuberculosis; ankle arthritis; extrapulmonary tuberculosis; osteoarticular tuberculosis; tuberculous arthritis.

Figure 1

An x-ray shows ankle osteoarthritis, with evidence of perimalleolar soft tissue swelling, periarticular calcifications and reduced bone mineral content

Figure 2

Magnetic resonance imaging shows hyper-intense thickening of the synovial membrane and structural alterations of the tibia, talus and calcaneus with several chondromatosis bodies in the anterior part of the tibiotalar joint

Figure 3

Longitudinal ankle joint incision

Figure 4

Histopathological features of the tibial lesion. The histopathological examination showed a lesion with large areas of necrosis (A) surrounded by fibrous tissue with dense lymphocytic (B) infiltrates and scattered granulomas (arrows)