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Malihy Z, Benaissa E, Ben Lahlou Y, Maleb A, Elouennass M. Osteoarticular tuberculosis of the ankle, a rare localization: a case report. Access Microbiol 2023; 5:000654.v3. [PMID: 37970090 PMCID: PMC10634493 DOI: 10.1099/acmi.0.000654.v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/10/2023] [Indexed: 11/17/2023] Open
Abstract
Tuberculosis poses a considerable public health problem in countries where the disease is endemic. Osteoarticular tuberculosis represents 3-5 % of all tuberculosis cases and 10-15 % of extra-pulmonary tuberculosis cases. Involvement of the foot and ankle is rarer. We report a case of osteoarticular tuberculosis of the ankle in a 71-year-old patient with type 2 diabetes and hypertension who presented to the trauma department of the Mohammed V Military Hospital with a painful swelling of the ankle. Standard X-rays and computed tomography scans of the ankle showed inflammatory involvement of the bone and joints. Antitubercular therapy was instituted. Given the context of endemicity, any atypical presentation of lingering bone lesions should raise the suspicion of an osteoarticular tuberculosis in order to ensure early therapeutic management.
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Affiliation(s)
- Zakaria Malihy
- Department of Bacteriology, Mohammed V Military Teaching Hospital/Faculty of Medicine and Pharmacy (University Mohammed V), Rabat, Morocco
| | - Elmostafa Benaissa
- Department of Bacteriology, Mohammed V Military Teaching Hospital/Faculty of Medicine and Pharmacy (University Mohammed V), Rabat, Morocco
| | - Yassine Ben Lahlou
- Department of Bacteriology, Mohammed V Military Teaching Hospital/Faculty of Medicine and Pharmacy (University Mohammed V), Rabat, Morocco
| | - Adil Maleb
- Laboratory of Microbiology, Mohammed VI University Hospital/Faculty of Medicine and Pharmacy (University Mohammed the first), Oujda, Morocco
| | - Mostafa Elouennass
- Department of Bacteriology, Mohammed V Military Teaching Hospital/Faculty of Medicine and Pharmacy (University Mohammed V), Rabat, Morocco
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Rafaoui A, Lamris MA, El Kassimi C, Fnini S, Rafai M. Diagnosis and treatment of osteo-articular tuberculosis of the foot and ankle (a five case series). Int J Surg Case Rep 2023; 111:108739. [PMID: 37690276 PMCID: PMC10498164 DOI: 10.1016/j.ijscr.2023.108739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION Osteo-articular tuberculosis is a rare manifestation of this disease, often posing diagnostic challenges that necessitate additional diagnostic imaging modalities such as radiography, CT, and MRI. This article presents a series of five cases involving tuberculosis affecting the bones of the foot and ankle, diagnosed at various stages. The patients received appropriate anti-tuberculosis medical treatment following national protocols, along with surgical interventions when necessary. CASE STUDIES In this series, we describe the clinical characteristics and management of five cases of foot and ankle bone tuberculosis. These cases were diagnosed at different stages, and all patients received standard anti-tuberculosis medical therapy according to national treatment guidelines. Surgical interventions were performed when deemed necessary to optimize patient outcomes. DISCUSSION The diagnosis of bone tuberculosis should be considered in any clinical scenario that presents with uncertain features, persistent symptoms, or resistance to conventional treatment approaches. It is crucial to employ a multidisciplinary approach involving medical and surgical management to effectively address this challenging disease. However, it is important to note that surgical intervention cannot replace the necessity of proper medical treatment. CONCLUSION Tuberculosis involving the bones of the foot and ankle remains an infrequent occurrence. However, considering the endemic context, prompt therapeutic interventions are essential to prevent significant osteoarticular damage. Early diagnosis, adherence to established treatment protocols, and a comprehensive approach encompassing both medical and surgical modalities are crucial for successful management of this rare entity.
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Affiliation(s)
- A Rafaoui
- 32 pavilion, CHU Ibn Rochd of Casablanca, Morocco
| | - M A Lamris
- 32 pavilion, CHU Ibn Rochd of Casablanca, Morocco.
| | - C El Kassimi
- 32 pavilion, CHU Ibn Rochd of Casablanca, Morocco
| | - S Fnini
- 32 pavilion, CHU Ibn Rochd of Casablanca, Morocco
| | - M Rafai
- 32 pavilion, CHU Ibn Rochd of Casablanca, Morocco
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Mjid M, Toujani S, Rekik S, Kanoun L, El Bey R, Ouahchi Y, Ben Salah N, Louzir B, El Euch M, Mehiri-Ben Rhouma N, Cherif J, Beji M. [Pulmonary tuberculosis revealed by chronic osteoarthritis of the ankle]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:214-217. [PMID: 27133174 DOI: 10.1016/j.pneumo.2015.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 10/01/2015] [Accepted: 11/18/2015] [Indexed: 06/05/2023]
Affiliation(s)
- M Mjid
- Service de pneumo-allergologie, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, CHU La Rabta, 1007 Tunis, Tunisie.
| | - S Toujani
- Service de pneumo-allergologie, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, CHU La Rabta, 1007 Tunis, Tunisie
| | - S Rekik
- Service de rhumatologie, faculté de médecine de Tunis, université de Tunis El Manar, CHU La Rabta, Tunis, Tunisie
| | - L Kanoun
- Service de chirurgie orthopédique, faculté de médecine de Tunis, université de Tunis El Manar, CHU La Rabta, Tunis, Tunisie
| | - R El Bey
- Service de pneumo-allergologie, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, CHU La Rabta, 1007 Tunis, Tunisie
| | - Y Ouahchi
- Service de pneumo-allergologie, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, CHU La Rabta, 1007 Tunis, Tunisie
| | - N Ben Salah
- Service de pneumo-allergologie, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, CHU La Rabta, 1007 Tunis, Tunisie
| | - B Louzir
- Service de pneumo-allergologie, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, CHU La Rabta, 1007 Tunis, Tunisie
| | - M El Euch
- Service de rhumatologie, faculté de médecine de Tunis, université de Tunis El Manar, CHU La Rabta, Tunis, Tunisie
| | - N Mehiri-Ben Rhouma
- Service de pneumo-allergologie, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, CHU La Rabta, 1007 Tunis, Tunisie
| | - J Cherif
- Service de pneumo-allergologie, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, CHU La Rabta, 1007 Tunis, Tunisie
| | - M Beji
- Service de pneumo-allergologie, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, CHU La Rabta, 1007 Tunis, Tunisie
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Lemnouer A, Frikh M, Belfquih B, Jaafar A, Bouya A, Jidal M, Boussouga M, Elouennass M. Navicular tuberculosis: A rare localization of bone tuberculosis. IDCases 2016; 2:80-2. [PMID: 26793464 PMCID: PMC4712193 DOI: 10.1016/j.idcr.2015.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 11/26/2022] Open
Abstract
Tuberculosis (TB) is a global public health problem endemic to Morocco. While extrapulmonary TB uncommonly presents in osteoarticular anatomic locations, tarsal or metatarsal osteitis can occur when TB presents in the tarsal bones. Clinical symptoms are often insidious causing a delay in diagnosis that may lead to bone destruction. While diagnosis can be guided by X-ray imaging, bacteriologic and histologic examination of the tissue allows for pathogen isolation, identification of the bacillus and strain sensitivity to antibacillary treatment. We report a rare case of navicular osteitis associated with tarso-metatarsal arthritis caused by tuberculosis in a 68-year-old man. This case illustrates an exceptional location of osteoarticular TB and support diagnostic difficulties encountered: (i) imaging is not specific; (ii) lesions are paucibacillary which reduces conventional microbiological methods sensitivity and (iii) the peripheral location of the Koch bacillus within the lesion dictates surgical biopsy than percutaneous puncture. We recommend testing for tuberculosis in any case of chronic osteolysis and/or arthritis of the foot, especially in TB endemic countries.
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Affiliation(s)
- Abdelhay Lemnouer
- Department of Bacteriology, University Mohammed V, Faculty of Medicine and Pharmacy, Military Hospital of Instruction Mohammed V Rabat, Rabat, Morocco
| | - Mohammed Frikh
- Department of Bacteriology, University Mohammed V, Faculty of Medicine and Pharmacy, Military Hospital of Instruction Mohammed V Rabat, Rabat, Morocco
| | - Bouchra Belfquih
- Department of Bacteriology, University Mohammed V, Faculty of Medicine and Pharmacy, Military Hospital of Instruction Mohammed V Rabat, Rabat, Morocco
| | - Abdelwahab Jaafar
- Department of Orthopedics, Military Hospital of Instruction Mohammed V, Rabat, Morocco
| | - Ayoub Bouya
- Department of Orthopedics, Military Hospital of Instruction Mohammed V, Rabat, Morocco
| | - Mohamed Jidal
- Department of Radiology, Military Hospital of Instruction Mohammed V, Rabat, Morocco
| | - Mustapha Boussouga
- Department of Orthopedics, Military Hospital of Instruction Mohammed V, Rabat, Morocco
| | - Mostafa Elouennass
- Department of Bacteriology, University Mohammed V, Faculty of Medicine and Pharmacy, Military Hospital of Instruction Mohammed V Rabat, Rabat, Morocco
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Koné S, Gbané-Koné M, Bana A, Touré SA, Kouassi AN, Koffi AG, Eti E, Kouakou NM. [Unusual multifocal osteoarthritis tuberculosis in an immunocompetent patient]. Pan Afr Med J 2015; 20:212. [PMID: 26113943 PMCID: PMC4470444 DOI: 10.11604/pamj.2015.20.212.6015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 03/03/2015] [Indexed: 12/02/2022] Open
Abstract
Les formes multifocales de la tuberculose, surviennent habituellement chez des sujets immunodéprimés. Dans les formes multifocales, certaines localisations osseuses sont rares. Les auteurs rapportent le cas d'une patiente de 58 ans, immunocompétente qui présentait une tuberculose multifocale associant une atteinte pulmonaire et des localisations osseuses et articulaires inhabituelles (l’épaule, la cheville et le pied homolatéral, la branche illio-pubienne). Le diagnostic a été histologique (biopsie ostéo-articulaire) et bactériologique (mise en évidence des BAAR dans les crachats). Le traitement a été médico-chirurgical.
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Affiliation(s)
- Samba Koné
- Service de Traumato-Orthopédie CHU de Cocody, Abidjan, Côte d'Ivoire
| | | | - Abdoulaye Bana
- Service de Traumato-Orthopédie CHU de Cocody, Abidjan, Côte d'Ivoire
| | | | | | - Akué Gérard Koffi
- Service de Traumato-Orthopédie CHU de Cocody, Abidjan, Côte d'Ivoire
| | - Edmond Eti
- Service de Rhumatologie CHU de Cocody, Abidjan, Côte d'Ivoire
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Chater L, Arroud M, Afifi MA. Tuberculosis of the calcaneus in children. Int J Mycobacteriol 2014; 3:57-9. [PMID: 26786224 DOI: 10.1016/j.ijmyco.2013.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 12/24/2013] [Accepted: 12/26/2013] [Indexed: 11/29/2022] Open
Abstract
Osteoarticular tuberculosis represents 1.7-2% of all tuberculosis (TB). The localization in the foot is rare and accounts for less than 10% of osteoarticular TB. The following report describes the case of a 7-year-old boy who presented with a gradually increasing inflammatory swelling over the lateral aspect of the right ankle. An X-ray of his right ankle showed an osteolytic image at the calcaneus. Diagnosis was confirmed by the presence of a tuberculoid granuloma with caseous necrosis on bone biopsy.
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Rico A, Paño JR, Cruz A. Osteomielitis crónica del pie. Enferm Infecc Microbiol Clin 2010; 28:200-2. [DOI: 10.1016/j.eimc.2009.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 07/03/2009] [Accepted: 07/07/2009] [Indexed: 10/20/2022]
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