[Tuberculous osteitis of the tarsal bones: a case report]

A thirty-year old woman presented with complaints of pain, swelling in her right ankle, and difficulty in walking that had a history of six months. The range of motion of the joint was limited. She did not get any benefit from various non-steroidal anti-inflammatory drugs. She had undergone surgery three years ago for pain in her right hip, difficulty in walking, and a swelling in the right inguinal area. She had an elevated erythrocyte sedimentation rate. Foot radiographs showed degeneration of the navicular and cuneiform bones. Hyperintensity in the same area on magnetic resonance scans was interpreted in favor of a chronic infection. Arthrotomy of the calcaneocuboid joint and the 3rd, 4th, and 5th tarsometatarsal joints was performed, with curettage of the cuboid and lateral cuneiform bones. Tissue samples were obtained from the synovium, joint capsule, and bone, among which Mycobacterium tuberculosis was recovered only in bone cultures. The patient manifested rapid improvement with antituberculous therapy. This case demonstrates the need to obtain cultures from the bone as well as those from the synovial fluid or tissues to identify tuberculosis of a very rare site of involvement.