Isolated first metatarsal Tuberculous osteomyelitis in paediatric patient: A Case Report Isolated first metatarsal Tuberculous osteomyelitis in paediatric patient: A Case Report

Abstract

Skeletal Tuberculosis (TB) is commonly affected spine and large joints like the hip and knee. Only few cases of isolated metatarsal involvement have been reported. However, because skeletal TB can mimic a wide range of acute and chronic conditions, it needs a high index of susception to prevent further joint involvement and damage. We report a case of two-year-old female patient complaining of mild to moderate right foot pain on palpating or wearing socks then after minor trauma she started to have swelling in the right upper dorms of the right foot with red discoloration and pain upon touch. X-ray and MRI of right foot showed osteomyelitis of the first metatarsal in the right foot. However, the clinical presentation did not match to the radiological finding. Thus, an open biopsy was requested and diagnosis of TB Osteomyelitis was done based on low detected Mycobacterium tuberculosis Complex. The patient started on Anti-TB regimen for one year. Patient responded to Anti-Tuberculosis drugs well, pain and swelling have been completely disappeared.

Keywords: Bone TB, tuberculosis, metatarsal, case report.

Introduction

Tuberculosis (TB) is the most serious public health problem in many countries. Although TB commonly affects the lungs, it can also spread to other parts of the body. This is known as extrapulmonary TB (1). The prevalence of Skeletal TB in the pediatric age group about 5-6% of extrapulmonary TB (2). Moreover, Spine and large joints like the hip and knee are commonly affected by TB. Only few cases of isolated metatarsal involvement have been reported (3).

Skeletal TB and Ankle and foot TB (AFTB) can mimic other disease such as pathological fractures, non-unions, dislocations, arthritis, ankylosis, instability, limb deformity, osteomyelitis, and wide range of acute and chronic condition. Therefore, The diagnosis of AFTB need high index of susception otherwise will be delayed or missed (2).

Even though, most of TB cases involving the foot and ankle are managed with TB chemotherapy, but there are some indications for surgery. Additionally, surgical intervention can also prevent joint destruction or spread of disease to adjacent joints if executed at the appropriate time (4). We report a case of two-year old girl with right first metatarsal bone TB Osteomyelitis. We propose that physician should be aware and have high index of susception for skeletal TB particularly in exceptional localization.