Tuberculosis of Talonavicular Joint Without Pulmonary Involvement in an Indian Child: A Report of a Rare Case

Pseudoarthrosis of the Femur Secondary to Tuberculosis: A Rare and First Report

Tuberculosis poses a major health problem worldwide, and more so in developing countries. Tuberculosis will exist for as long as there are facets of malnutrition, poor sanitation, overcrowding, and immunocompromised populations. We report a rare case of pseudoarthrosis of the femur secondary to tuberculosis. A five-year-old female child presented with swelling, discharging sinuses, and abnormal mobility in the right lower one-third of the thigh secondary to trauma seven months ago. Incision, drainage, and debridement were done, and the obtained pus showed no growth. The sample turned out to be acid-fast bacilli-positive. The patient was on anti-tubercular drugs for six months and had a protective plaster cast for about six weeks, following which knee mobilization was started. During knee mobilization, the patient underwent a forced manipulation of the lower end of the femur, and the radiograph revealed a pathological fracture for which one-and-a-half hip-spica was applied. Further radiographs revealed an un-united fracture after three months despite hip spica application, and a pseudoarthrosis of the right distal femur developed, for which non-vascularized fibular strut grafting for pseudoarthrosis of the distal third of the femur was performed and stabilized with two 2.5 mm-long K-wires supplemented with hip spica for six months. The patient was followed up regularly, and subsequent radiographs showed fibular uptake and resolution of pseudoarthrosis of the femur at the eighth-month follow-up. The patient showed complete resolution of pseudoarthrosis and an excellent functional outcome by the end of the two-year follow-up.

Primary Tuberculosis of the Cuboid and Fifth Metatarsal Without Pulmonary Involvement: A Rare Case Report

Tuberculosis affecting the smaller bones of the foot is relatively infrequent. There is a paucity of data related to the tubercular involvement of cuboid and metatarsal bones. Diagnosis is challenging, especially in the absence of pulmonary involvement, a history of trauma, and contact with tuberculosis. We present a rare case of primary tuberculosis of the cuboid and fifth metatarsal without pulmonary involvement. The patient was started on anti-tubercular chemotherapy. A detailed literature search revealed that no such case with concomitant involvement of the cuboid and fifth metatarsal without pulmonary seeding has ever been reported.

Isolated Tuberculous Mediastinal Lymphadenopathy in an Immunocompetent Child Without Pulmonary Involvement: A Case Report

Tuberculosis continues to be a big challenge to public health. Isolated cases of tuberculous mediastinal lymphadenopathy in an immunocompetent child without pulmonary involvement are relatively rare. Compared to adults, children are susceptible to such infections; however, due to a lack of specific clinical features and the involvement of invasive techniques in establishing the diagnosis, there are chances of a diagnostic delay. A case of a nine-year-old girl who reported having chest pain for one month is presented. In the absence of the constitutional signs and symptoms of tuberculosis, a diagnosis was confirmed with computed tomography, histopathology, and cartridge-based nucleic acid amplification of samples obtained from endobronchial ultrasound-guided transbronchial needle aspiration. She was put on anti-tuberculous treatment for her weight.

Isolated Tuberculosis of the First Metatarsal of the Right Foot Without Pulmonary Involvement: A Rare Case

Tuberculosis of the small bones of the foot is a rare clinical condition. Oftentimes, there is a delay in diagnosis, which could adversely affect the results. Isolated cases of tuberculosis of the first metatarsal of the right foot without pulmonary involvement are seldom reported. Herein, a case of a 13-year-old Indian female who presented with complaints of pain, swelling, and discharge from her right foot is presented. A diagnostic workup led to a definite diagnosis of isolated tuberculosis of the first metatarsal of the right foot without pulmonary involvement, and she was put on anti-tubercular treatment.

Isolated Tuberculosis of the First Metatarsal of the Left Foot With Congenital Hallux Valgus Without Pulmonary Involvement: A First of Its Type Case

Osteomyelitis caused by Mycobacterium tuberculosis is a rare entity. This clinical condition is even rarer when the bones of extremities like the foot are involved. There is a paucity of literature on the isolated tubercular involvement of the bones of the foot. Further, congenital hallux valgus is an infrequently reported condition. A case of tuberculosis of the first metatarsal of the left foot with congenital hallux valgus without pulmonary involvement is never reported in the literature. We herein present a first of its type case where tuberculous osteomyelitis of the first metatarsal of the left foot with congenital hallux valgus was diagnosed with the help of radiology, cartridge-based nucleic acid amplification test, and pus culture. The patient was initiated on anti-tubercular treatment but was ultimately lost to follow-up.

Tuberculosis of the Right Fifth Metatarsal and Fourth Web Space Without Pulmonary Involvement: A Rare Case

Tuberculosis of the bones and joints is an uncommon entity. The bacterial infection of small bones of the foot, like the metatarsals, is extremely rare. Such cases are often detected late, and as a result, there is delayed management. The present case is that of a 12-year-old Indian boy who came with complaints of pain and swelling below his right foot. In the absence of pulmonary involvement, a definite diagnosis of tuberculosis of the fifth metatarsal with fourth web space was established using histopathology, a cartridge-based nucleic acid amplification test, magnetic resonance imaging, and culture of the pus. He was prescribed first-line anti-tubercular treatment for 12 months.

Tuberculous Osteomyelitis of the Left Fifth Metatarsal and Phalanx Without Pulmonary Involvement: A First-of-Its-Type Report

Tuberculosis manifesting at extrapulmonary sites is relatively rare. Isolated cases involving small bones of the foot are the rarest of the rare. We herein present the case of a 30-year-old Indian female who presented with pain and a wound with a discharging sinus over her left foot. In the absence of constitutional symptoms of tuberculosis, this case was diagnosed as isolated tuberculous osteomyelitis of the left fifth metatarsal and phalanx with the help of radiography, a cartridge-based nucleic acid amplification test, a line probe assay, a culture of the biopsy specimen, and magnetic resonance imaging. She was initiated on anti-tubercular treatment per national guidelines.