Atypical presentation of musculoskeletal tuberculosis in the ankle: A case report

Abstract

Tuberculosis (TB) remains a significant global health challenge, with extrapulmonary TB making up about 10 % of all cases. Musculoskeletal TB is a minor component of these cases, with TB of the ankle and foot being exceptionally uncommon, accounting for just 0.1–0.3 % of extrapulmonary TB instances. We introduce a diagnostically challenging case involving a 30-year-old South Asian male who developed primary TB osteomyelitis of the left ankle, which initially presented as a non-healing ulcer resistant to conventional antibiotic treatment.

Characteristic features of osteomyelitis with associated soft tissue involvement were demonstrated by advanced imaging studies, including MRI. The definitive diagnosis was made through PCR and culture confirmation of Mycobacterium tuberculosis from surgical specimens. A thorough evaluation uncovered the presence of concomitant pulmonary TB, underscoring the significance of systemic assessment in cases of extrapulmonary presentations. The patient was effectively treated using a combination of surgical debridement and standard anti-tubercular therapy, showing a favorable early response.

This case demonstrates several vital clinical lessons: the importance of keeping a high suspicion for TB in persistent musculoskeletal lesions, especially in patients from endemic regions; the worth of state-of-the-art diagnostic methods in atypical presentations; and the significance of examining for concurrent pulmonary involvement even in cases of extrapulmonary disease that appear to be isolated. The report bolsters existing guidelines that advocate for a multidisciplinary strategy in TB management, integrating precise microbiological diagnosis, suitable imaging, and extended antimicrobial treatment to avert long-term consequences. Clinicians working in both endemic and non-endemic areas may find these findings especially relevant, as they may come across such atypical presentations.