Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 9 , ISSUE 4 ( October-December, 2022 ) > List of Articles

CASE REPORT

Multifocal Tubercular Osteomyelitis of Metatarsal and Ulna: A Case Report

Neetin P Mahajan, Pranay Kondewar, GS Prasanna Kumar, Shubham Atal, Amey Sadar

Keywords : Antitubercular treatment, Curettage, Metatarsal and ulna, Tubercular osteomyelitis

Citation Information : Mahajan NP, Kondewar P, Kumar GP, Atal S, Sadar A. Multifocal Tubercular Osteomyelitis of Metatarsal and Ulna: A Case Report. J Foot Ankle Surg Asia-Pacific 2022; 9 (4):183-187.

DOI: 10.5005/jp-journals-10040-1193

License: CC BY-NC 4.0

Published Online: 07-10-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Introduction: Skeletal tuberculosis is relatively uncommon compared with the pulmonary form of tuberculosis. Bones and joints are affected in 1–3% of all cases, the spine and hip are most commonly involved. Localization in the foot is very rare. Management of tubercular osteomyelitis of metatarsals includes medical/surgical or both depends on the severity and location of the disease. Case description: A 25-year-old female patient presented with complaints of pain, swelling over the medial aspect of the right foot for 6 months. She had a history of left proximal ulna tubercular osteomyelitis 6 years ago, for which curettage was done and she took AKT for 6 months. X-ray foot showed a cavitary lytic lesion in the proximal part of the first metatarsal bone. It was managed with debridement, curettage, and saucerization of the metatarsal bone and CAT2 AKT. At present 1-year follow-up, the patient is comfortable with no pain, difficulty in weight-bearing, and no recurrence. X-ray foot revealed complete filling of the defect in the metatarsal with remineralization with no recurrence and fracture. Conclusion: Although metatarsal and olecranon tubercular osteomyelitis involvement is rare, early diagnosis and management help in getting a better outcome. Early surgical intervention and antitubercular treatment help in preventing further progression to adjacent joint/bone/soft tissue. Along with long-term AKT, high protein and nutritious diet help in maintaining good immunity and helps in preventing recurrence.


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  1. Mittal R, Gupta V, Rastogi S. Tuberculosis of the foot. J Bone Joint Surg Br 1999;81(6):997–1000. DOI: 10.1302/0301-620x.81b6.9925
  2. Dhillon MS, Sharma S, Gill SS, et al. Tuberculosis of bones and joints of the foot: an analysis of 22 cases. Foot Ankle 1993;14(9):505–513. DOI: 10.1177/107110079301400904
  3. Subasi M, Bukte Y, Kapukaya A, et al. Tuberculosis of the metacarpals and phalanges of the hand. Ann Plastic Surg 2004;53(5):469–472. DOI: 10.1097/01.sap.0000130708.80606.6a
  4. Andronikou S, Smith B. Spina ventosa-tuberculous dactylitis. Arch Dis Child 2002;86(3):206. DOI: 10.1136/adc.86.3.206
  5. Benkeddache Y, Gottesman H. Skeletal tuberculosis of the wrist and hand: a study of 2 cases. J Hand Surg 1982;7(6):593–600. DOI: 10.1016/s0363-5023(82)80109-3
  6. Dhillon MS, Nagi ON. Tuberculosis of the foot and ankle. Clin Orthop Relat Res 2002;398(398):107–113. DOI: 10.1097/00003086-200205000-00015
  7. Yuen MC, Tung WK. An uncommon cause of foot ulcer: tuberculosis osteomyelitis. Emerg Med J 2001;18(2):140–141. DOI: 10.1136/emj.18.2.140
  8. Vervest TM, Nollen AJ, de Munck DR. A case of spina ventosa. Acta Orthop Scand 1998;69(3):322–323. DOI: 10.3109/17453679809000940
  9. Watts HG, Lifeso RM. Current concepts review: tuberculosis of bone and joints. J Bone Joint Surg Am 1996;78(2):288–298. DOI: 10.2106/00004623-199602000-00019
  10. Versfeld GA, Solomon A. Adiagnostic approach to tuberculosis of bones and joints. J Bone Joint Surg Br 1982;64(4):446–449. DOI: 10.1302/0301-620X.64B4.7096418
  11. Dhillon MS, Gupta R, Srinivas S, et al. Bilateral sternoclavicular joint tuberculosis: Arch Orthop Trauma SurgA case report. 2000;120(5–6): 363–365. DOI: 10.1007/s004020050486
  12. Vijay V, Sud A, Mehtani A. Multifocal bilateral metatarsal tuberculosis: a rare presentation. J Foot Ankle Surg 2015;54(1):112–115. DOI: 10.1053/j.jfas.2014.09.030
  13. Flint JD, Saravana S. Tuberculous osteomyelitis of the midfoot: Cases Ja case report. 2009;2(1):6859. DOI: 10.4076/1757-1626-2-6859
  14. Varun V, Naveen S, Anuj R, et al. Multifocal Tubercular Osteomyelitis: A Case Report in an Immunocompetent Patient. Sch J App Med Sci 2015;3(3H):1590–1593..
  15. Hu S, Guo J, Ji T, et al. Multifocal osteoarticular tuberculosis of the extremities in an immunocompetent young man without pulmonary disease: Exp Ther MedA case report. 2015;9(6):2299–2302. DOI: 10.3892/etm.2015.2425
  16. Ganda V, Kadu V, Godghate N, et. al. Unusual site of tubercular osteomyelitis of 5th metatarsal. Int J Health Sci Res 2015;5(2):479–482.
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