Brew C J, Rao V, Shanker J
Bradford Royal Infirmary, West Yorkshire, United Kingdom.
Foot (Edinb). 2010 Dec;20(4):146-8. doi: 10.1016/j.foot.2010.08.001. Epub 2010 Sep 15.
Isolated tuberculosis osteomyelitis affecting the foot is extremely rare. Symptoms are nonspecific and haematological investigations are often unhelpful making diagnosis difficult. We report the case of a 41-year-old female who presented with a 7-month history of a painful hindfoot following a minor ankle sprain. Inflammatory markers were mildly raised and initial radiographs showed only some mild narrowing of the talonavicular joint. MRI scanning suggested osteomyelitis centred over the talonavicular joint. Open biopsy confirmed areas of caseous necrosis but no acid-fast bacilli were seen. The final diagnosis was confirmed with culture of mycobacterium tuberculosis. A good recovery was seen following debridement and commencement of anti-tuberculosis chemotherapy. Unless an awareness of this condition exists, the diagnosis and therefore the appropriate treatment can often be delayed which may lead to significant consequences for the patient.
孤立性足部结核性骨髓炎极为罕见。症状不具特异性，血液学检查往往无助于诊断，使得诊断困难。我们报告一例41岁女性病例，她在轻微踝关节扭伤后出现后足疼痛7个月的病史。炎症标志物轻度升高，最初的X线片仅显示距舟关节有一些轻度狭窄。MRI扫描提示距舟关节为中心的骨髓炎。开放活检证实有干酪样坏死区域，但未发现抗酸杆菌。结核分枝杆菌培养确诊了最终诊断。清创及开始抗结核化疗后病情明显好转。除非认识到这种疾病，否则诊断及相应治疗常常会延迟，这可能给患者带来严重后果。
