Challenges and Triumphs: Unusual Presentation of Tuberculosis in the Cuboid Bone Successfully Managed Through Surgical and Medical Intervention

Abstract

This case report describes the unusual presentation of tuberculosis (TB) affecting the cuboid bone in a 16-year-old male patient. The patient presented with a one-year history of progressive foot pain, a discharging sinus, evening rise of temperature, weight loss, and loss of appetite. Clinical examination revealed soft tissue swelling and the presence of caseous material oozing from the sinus. Emergency debridement and curettage were performed, and bone cementing was carried out. An intraoperative sample was sent for a culture sensitivity test, histological analysis, and cartridge-based nucleic acid amplification test (CBNAAT). Histopathological examination, CBNAAT, and culture and sensitivity tests confirmed the diagnosis of Mycobacterium tuberculosis infection. Post-operatively, anti-tuberculous treatment was started. The patient fully recovered from TB of the cuboid.

Keywords: cuboid tuberculosis; extrapulmonary tuberculosis; foot tuberculosis; osteoarticular tuberculosis; tuberculosis osteomyelitis of foot.

Figure 1. X-ray of the right foot in anteroposterior (A) and oblique (B) views showing an osteolytic lesion over cuboid bones along with soft tissue swelling and diffuse transient osteopenia

Figure 2. MRI of the right foot T2W (A) and T1W (B) images in the coronal view showing T1W hypointense signals and T2W hyperintense marrow signals involving the cuboid bone with an associated cortical break and sinus tract suggestive of osteomyelitis

Figure 3. Post-operative X-ray of the right foot in anteroposterior (A) and oblique (B) views showing that the cuboid bone was filled with bone cement, the infection was resolved, and the cuboid lesion was consolidated