Osteoarticular tuberculosis of the ankle, a rare localization: a case report

Abstract

Tuberculosis poses a considerable public health problem in countries where the disease is endemic. Osteoarticular tuberculosis represents 3-5 % of all tuberculosis cases and 10-15 % of extra-pulmonary tuberculosis cases. Involvement of the foot and ankle is rarer. We report a case of osteoarticular tuberculosis of the ankle in a 71-year-old patient with type 2 diabetes and hypertension who presented to the trauma department of the Mohammed V Military Hospital with a painful swelling of the ankle. Standard X-rays and computed tomography scans of the ankle showed inflammatory involvement of the bone and joints. Antitubercular therapy was instituted. Given the context of endemicity, any atypical presentation of lingering bone lesions should raise the suspicion of an osteoarticular tuberculosis in order to ensure early therapeutic management.

Keywords: PCR; ankle; tuberculosis.

Fig. 1.

An acid-fast bacillus (AFB; red arrow) found on direct examination using Ziehl–Neelsen staining (Magnification 1000x).

Fig. 2.

Axial ankle CT (a and b) scan showing diffuse infiltration of the soft tissues (red arrows) with significant gas extending from subcutaneous soft tissues and penetrating between bone structures (blue arrows). Note loss of cutaneous substance (white arrows).

Fig. 3.

Axial CT scan mediastinal (a, b and c) and lung (d) windows showing bilateral pleural effusion (blue arrows) which is more pronounced on the right side.