Navicular tuberculosis: A rare localization of bone tuberculosis

Area of Science:

• Orthopedics
• Infectious Diseases
• Radiology

Background:

• Tuberculosis (TB) is a significant global health issue, particularly prevalent in endemic regions like Morocco.
• Extrapulmonary TB, while less common, can manifest in osteoarticular locations, including the tarsal and metatarsal bones.
• Tarsal osteitis due to TB often presents insidiously, delaying diagnosis and potentially leading to severe bone destruction.

Purpose of the Study:

• To report a rare case of tuberculosis-induced navicular osteitis and tarso-metatarsal arthritis.
• To highlight the diagnostic challenges associated with osteoarticular TB in the foot.
• To emphasize the importance of considering TB in cases of chronic foot osteolysis or arthritis.

Main Methods:

• Case report of a 68-year-old male patient.
• Clinical and radiological evaluation.
• Histopathological and microbiological examination of surgical biopsy tissue.

Main Results:

• A rare case of navicular osteitis and tarso-metatarsal arthritis caused by tuberculosis was identified.
• Diagnostic challenges included non-specific imaging findings and paucibacillary nature of the lesions.
• Surgical biopsy was essential for pathogen identification and sensitivity testing due to the peripheral location of the bacilli.

Conclusions:

• Osteoarticular tuberculosis of the foot is an exceptional presentation requiring a high index of suspicion.
• Diagnostic difficulties stem from non-specific imaging, low bacterial load, and the need for invasive biopsy.
• Testing for tuberculosis should be considered in all cases of chronic foot osteolysis or arthritis, especially in TB-endemic areas.