Tuberculosis of the Navicular Bone of the Left Foot Without Pulmonary Involvement in a Fifteen-Year-Old Indian Boy: A Rare Case Report

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.

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.