Kunnath Febin, Bhowmick Kaushik, P R J V C Boopalan
Orthopaedics, Christian Medical College and Hospital, Vellore, IND.
Cureus. 2020 Dec 15;12(12):e12090. doi: 10.7759/cureus.12090.
The coexistence of giant cell tumor (GCT) and metatarsal bone tuberculosis (TB) of the foot has not been reported in the literature so far. We report a case of a 25-year-old male who presented with severe pain and swelling of his left foot for two months, which was aggravated on walking. A plain radiograph of the left foot showed an expansile eccentric lytic lesion of the base of the second metatarsal. He underwent extended curettage and antibiotic cement spacer insertion. Biopsy of the lesion revealed the presence of GCT, while tissue cultures were positive for Mycobacterium tuberculosis. He was treated with standard anti-tubercular treatment (ATT), four drug regimens for twelve months. He then underwent reconstruction of the second metatarsal with cement spacer exit and iliac crest bone grafting, following which the cultures were negative for TB. The diagnosis of this unexpected and unique combination of pathologies (GCT and TB) depends on a high index of clinical suspicion, relevant investigations, and accurate histological diagnosis.
足部骨巨细胞瘤（GCT）与跖骨结核（TB）并存的情况目前在文献中尚未见报道。我们报告一例25岁男性患者，其左脚严重疼痛、肿胀两个月，行走时加重。左脚X线平片显示第二跖骨基部有一膨胀性偏心溶骨性病变。他接受了扩大刮除术并植入抗生素骨水泥间隔物。病变活检显示存在骨巨细胞瘤，而组织培养结核分枝杆菌呈阳性。他接受了标准抗结核治疗（ATT），采用四联药物方案，疗程12个月。之后，他接受了第二跖骨重建术，取出骨水泥间隔物并进行髂嵴植骨，术后结核培养结果为阴性。这种意外且独特的病理组合（骨巨细胞瘤和结核）的诊断依赖于高度的临床怀疑指数、相关检查以及准确的组织学诊断。
