[Non-healing foot wound]

Area of Science:

• Medicine
• Infectious Diseases
• Dermatology

Background:

• Tuberculosis (TB) is a significant global health concern, primarily affecting the lungs but capable of manifesting in various extrapulmonary forms.
• Minor trauma can, in rare cases, trigger the reactivation of latent tuberculosis infections.
• Suppurative chronic wounds present diagnostic challenges, especially when initial treatments are ineffective.

Observation:

• A young male patient from Sri Lanka presented with a non-healing, suppurative chronic wound on his right foot following minor trauma.
• Multiple surgical interventions failed to achieve wound closure, highlighting the atypical nature of the lesion.
• The patient subsequently developed severe miliary tuberculosis, prompting a re-evaluation of the foot wound's etiology.

Findings:

• The chronic foot wound was ultimately diagnosed as a manifestation of tuberculosis, likely reactivated by the initial trauma.
• The development of miliary tuberculosis indicated disseminated disease, underscoring the severity of the underlying infection.
• Initiation of tuberculostatic therapy led to the management of both the disseminated disease and the chronic wound.

Implications:

• This case highlights the importance of considering tuberculosis in the differential diagnosis of chronic, non-healing wounds, particularly in endemic regions or in patients with risk factors.
• Trauma-induced reactivation of tuberculosis, though rare, can lead to severe disseminated disease and unusual presentations.
• Early and accurate diagnosis of extrapulmonary tuberculosis is crucial for effective treatment and improved patient outcomes, preventing complications like miliary spread.