Kasai Taro, Yamada Atsuhisa, Yasui Tetsuro
Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, JPN.
Orthopedic Surgery, Teikyo University Mizonokuchi Hospital, Kawasaki, JPN.
Cureus. 2025 Jun 11;17(6):e85758. doi: 10.7759/cureus.85758. eCollection 2025 Jun.
Tuberculosis of the foot is an uncommon form of extrapulmonary tuberculosis, and tuberculosis of the first metatarsophalangeal (MTP) joint is extremely rare. We report the case of a healthy 31-year-old woman from the Philippines with a three-year history of swelling and pain in her left first MTP joint. Foot imaging revealed severe bone destruction and granulation tissue formation at the first MTP joint. Chest imaging showed no pulmonary involvement. was identified from the granulation tissue at the first MTP joint, leading to a diagnosis of isolated tuberculosis of the first MTP joint. Surgical debridement, including resection of the first metatarsal head, was performed, followed by a six-month course of anti-tuberculous chemotherapy. Throughout the three-year postoperative follow-up period, the patient exhibited no symptoms or radiographic signs suggestive of infectious relapse. This case underscores the importance of considering skeletal tuberculosis in chronic monoarthritis of the first MTP joint, even in the absence of pulmonary symptoms. To our knowledge, previous reports of tuberculosis in the first MTP joint have been limited to short-term follow-up. This case demonstrates the effectiveness of combined metatarsal head resection and anti-tuberculous chemotherapy in achieving sustained infection control over the mid-term follow-up.
足部结核是肺外结核的一种罕见形式，第一跖趾关节结核极为罕见。我们报告一例来自菲律宾的31岁健康女性，其左第一跖趾关节肿胀疼痛三年。足部影像学显示第一跖趾关节严重骨质破坏和肉芽组织形成。胸部影像学显示无肺部受累。从第一跖趾关节的肉芽组织中鉴定出结核分枝杆菌，从而诊断为孤立性第一跖趾关节结核。进行了手术清创，包括切除第一跖骨头，随后进行了为期六个月的抗结核化疗。在术后三年的随访期内，患者未出现提示感染复发的症状或影像学征象。该病例强调了在第一跖趾关节慢性单关节炎中考虑骨结核的重要性，即使没有肺部症状。据我们所知，先前关于第一跖趾关节结核的报道仅限于短期随访。该病例证明了联合跖骨头切除和抗结核化疗在中期随访中实现持续感染控制的有效性。
