1
|
Tatari A, Ramanujam S, Mathai S, Karabulut N, Moser RL, Wallach SL. Miliary tuberculosis and acquired immunodeficiency syndrome - 'a cursed duet'. J Community Hosp Intern Med Perspect 2016; 6:32131. [PMID: 27802849 PMCID: PMC5089153 DOI: 10.3402/jchimp.v6.32131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/08/2016] [Accepted: 08/11/2016] [Indexed: 11/14/2022] Open
Abstract
Tuberculous osteomyelitis is rare and usually involves the vertebrae but is seldom found in the foot. The uncommon site and ability to mimic other disorders clinically and radiographically leads to diagnostic and therapeutic delays. We report a case of a 40-year-old man who initially presented to his podiatrist with intermittent pain and swelling of his right ankle and foot that lasted for a year. He also started to exhibit significant weight loss and unexplained fevers and was subsequently hospitalized for cellulitis of his right foot. On further workup, patient was found to have miliary tuberculosis (TB) and acquired immunodeficiency syndrome (AIDS). Patient was treated with anti-TB therapy for 9 months and highly active anti-retroviral therapy. Our patient presented with ongoing chronic right foot and ankle pain that was proven to be secondary to TB osteomyelitis of cuneiform bones of the right ankle in the setting of AIDS. The patient's clinical presentation was unusual due to symptom duration and lack of systemic characteristics. Like our case, reported incidence of osteomyelitis of bone/joint in extrapulmonary TB is estimated to be 10%, and out of all bones/joint TB cases, only 1% are found to be in the foot.
Collapse
Affiliation(s)
- Atif Tatari
- Department of Internal Medicine, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA.,Department of Medicine, St Francis Medical Center, Trenton, NJ, USA;
| | - Sahana Ramanujam
- Department of Internal Medicine, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA.,Department of Medicine, St Francis Medical Center, Trenton, NJ, USA
| | - Suja Mathai
- Section of Infectious Disease, Department of Internal Medicine, St. Francis Medical Center, Trenton, NJ, USA
| | - Nigahus Karabulut
- Section of Infectious Disease, Department of Internal Medicine, St. Francis Medical Center, Trenton, NJ, USA
| | - Robert L Moser
- Department of Pathology, St Francis Medical Center, Trenton, NJ, USA
| | - Sara L Wallach
- Department of Internal Medicine, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA.,Department of Medicine, St Francis Medical Center, Trenton, NJ, USA
| |
Collapse
|