Nogdallah Sami, Mustafa M Elghazali Abuelgassim E, Khairy Alaa Mohamed, Fatooh Montaser, Abd-Elmaged Hozaifa Mohammed Ali
Al-Neelain University Khartoum Sudan.
Alzaiem Alazhari University Khartoum Sudan.
Clin Case Rep. 2023 Jun 13;11(6):e7483. doi: 10.1002/ccr3.7483. eCollection 2023 Jun.
It is important to consider foot and ankle tuberculosis (TB) as a potential cause of cystic lesion around the ankle, especially in patients with a history of TB. Early diagnosis and treatment with a rifampin-based regimen for a duration of 12 months can lead to good functional and clinical outcomes.
Skeletal TB is an uncommon accounting for 10% of extra-pulmonary TB may present slowly over an extended period of time, making a diagnosis difficult and time-consuming (Microbiology Spectr. 2017;5:5). For the best possible outcome and to reduce the risk of deformity diagnosis must be early (Foot (Edinb). 2018;37:105). For the treatment of drug-susceptible musculoskeletal illness, a rifampin-based regimen lasting 12 months is advised (Clin Infect Dis. 2016;63:e147; J Bone Joint Surg Br. 1993;75:240; Tubercle. 1986;67:243). A 33-year-old female who are working as nurse with diffuse, persistent and low in intensity ankle pain not aggravated relieved by analgesia and swelling over a period of 2 months, static not related to activity. With past medical history of partially treated pulmonary TB 1 year ago. She reported night sweats and low-grade fever during this period, and she denied any history of trauma. The right ankle was globally swollen and tender anteriorly and on the lateral malleolus. The skin over the ankle showed dark discoloration with cautery marks with no discharging sinuses. The range of motion of the right ankle was decreased. The plain x-ray of the right ankle showed three cystic lesion at the distal tibia, one cyst at the lateral malleolus and another one at the calcaneum. Surgical biopsy and expert gene test confirmed the diagnosis of tuberculous osteomyelitis. The patient was planned for surgical curettage of the lesion. After the confirmation of the diagnosis of TB with the biopsy and gene expert test, with consultation of senior chest physician the patient fitted to anti-tuberculous regimen. The patient had good functional and clinical outcome. This case report highlights the importance of considering skeletal TB as a potential cause of musculoskeletal symptoms, especially in patients with a history of TB. Early diagnosis and treatment with a rifampin-based regimen for a duration of 12 months can lead to good functional and clinical outcomes. Further research on the management and prevention of musculoskeletal TB is warranted to improve patient outcomes. The lesson behind this case is that the diagnosis TB osteomyelitis should be on the top of differential diagnosis of multiple cystic lesions around the foot and ankle especially in area where TB is endemic. Early diagnosis and early start of anti-tuberculous therapy can lead to full cure of the patient and in bad situation can minimize the complications.
重要的是要将足踝部结核视为踝关节周围囊性病变的潜在病因，尤其是有结核病史的患者。采用基于利福平的方案进行为期12个月的早期诊断和治疗可带来良好的功能和临床结局。
骨结核并不常见，占肺外结核的10%，可能在较长时间内缓慢出现，导致诊断困难且耗时（《微生物学光谱》。2017年；5:5）。为获得最佳结局并降低畸形风险，必须早期诊断（《足（爱丁堡）》。2018年；37:105）。对于药物敏感的肌肉骨骼疾病的治疗，建议采用基于利福平的方案，持续12个月（《临床感染病杂志》。2016年；63:e147；《英国骨与关节外科杂志》。1993年；75:240；《结核》。1986年；67:243）。一名33岁女性，职业为护士，踝关节弥漫性、持续性疼痛，疼痛程度较轻，镇痛不能缓解，且在2个月内出现肿胀，肿胀情况与活动无关。1年前有部分治疗的肺结核病史。在此期间，她报告有盗汗和低热，否认有任何外伤史。右踝关节整体肿胀，前侧和外踝压痛。踝关节皮肤呈暗褐色，有烧灼痕迹，无窦道流脓。右踝关节活动范围减小。右踝关节X线平片显示胫骨远端有3个囊性病变，外踝有1个囊肿，跟骨有1个囊肿。手术活检和专家基因检测确诊为结核性骨髓炎。计划对该患者进行病变的手术刮除。在通过活检和基因专家检测确诊为结核后，经资深胸科医生会诊，该患者适合抗结核治疗方案。患者获得了良好的功能和临床结局。本病例报告强调了将骨结核视为肌肉骨骼症状潜在病因的重要性，尤其是有结核病史的患者。采用基于利福平的方案进行为期12个月的早期诊断和治疗可带来良好的功能和临床结局。有必要对肌肉骨骼结核的管理和预防进行进一步研究以改善患者结局。该病例背后的经验教训是，在鉴别诊断足踝周围多个囊性病变时，尤其是在结核病流行地区，结核性骨髓炎的诊断应列为首要考虑。早期诊断和尽早开始抗结核治疗可使患者完全治愈，在情况不佳时可将并发症降至最低。
