Navigating Foot Tuberculosis in a Leprosy Survivor: A Case Managed Solely With Medical Strategies

Abstract

We present a case report of a 66-year-old male patient with a known history of leprosy who presented with pain and swelling in his right foot for the past 1.5 years. Fine needle aspiration cytology (FNAC) revealed non-inflammatory exudate, and Mycobacterium tuberculosis (MTB) was identified in the sample by the cartridge-based nucleic acid amplification test (CBNAAT). The patient was managed conservatively with anti-Koch's treatment (AKT), and a follow-up was conducted for 12 months to monitor the treatment response and overall progress. This highlights the importance of early diagnosis and appropriate medical management, along with a long-term follow-up, among patients with ankle tuberculosis, to reduce the need for surgical intervention.

Keywords: extrapulmonary tuberculosis; foot tuberculosis; leprosy; osteoarticular tuberculosis; tuberculosis osteomyelitis of the foot.

Figure 1. X-ray of right foot anteroposterior (A) and oblique (B) views showing generalized osteoporosis, periarticular soft tissue edema, subchondral erosions, or destructive lesions in the tarsal bones and base of the metatarsals suggestive of osteomyelitis changes; absence fracture seen.

Figure 2. X-ray of right ankle lateral (A) and mortise (B) views showing osteomyelitis changes of the right intertarsal joints and tarsometatarsal joints.

Figure 3. X-ray of right foot anteroposterior (A) and oblique (B) views showing lytic lesions noted in the tarsal bones. No bony erosion or destruction was noted. The joint space appeared normal. No other osteomyelitis changes were seen.

Figure 4. X-ray of right ankle lateral (A) and mortise (B) views showing only lytic lesions noted in the tarsal bones. No other osteomyelitis changes were seen.