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An isolated case of first metatarsal tuberculosis.

Madi S, Naik M, Vijayan S, Rao S - Oxf Med Case Reports (2015)

Bottom Line: An apparently healthy adolescent presented to us with multiple discharging sinuses from his right foot for the past 1 year.All serological parameters were within normal limits.X-ray picture revealed an expansile osteolytic lesion of first metatarsal.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedics , Kasturba Medical College, Manipal University , Udupi, Karnataka , India.

ABSTRACT
An apparently healthy adolescent presented to us with multiple discharging sinuses from his right foot for the past 1 year. All serological parameters were within normal limits. X-ray picture revealed an expansile osteolytic lesion of first metatarsal. Tissue biopsy and PCR confirmed it be of tubercular etiology. The incidence of isolated occurrence of metatarsal tuberculosis is very rare and the diagnostic dilemma it brings about is briefly discussed in the following report.

No MeSH data available.


Related in: MedlinePlus

Plain X-rays (antero-posterior and oblique views) of right foot showing an expansile osteolytic lesion (arrow pointing) with thinning of overlying cortex (arrow heads) of the first metatarsal.
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OMV021F2: Plain X-rays (antero-posterior and oblique views) of right foot showing an expansile osteolytic lesion (arrow pointing) with thinning of overlying cortex (arrow heads) of the first metatarsal.

Mentions: A 19-year-old boy presented to our foot and ankle clinic with pain and wound over right foot for past 1 year. There was ‘watery’ discharge coming from the wound on and off which started spontaneously and subsided by taking antibiotics. There was no history of trauma or any constitutional symptoms. On examination, there were five active discharging sinuses over dorsum of right foot all clustered around first and second ray (Fig. 1). All serological parameters were within normal limits (Table 1) and chest X-ray was also apparently normal. X-ray of foot revealed an expansile osteolytic lesion of the first metatarsal shaft with cortical thinning (Fig. 2). MRI of foot revealed a lytic lesion measuring 26 × 22 mm involving the head, proximal shaft and base of first metatarsal and a sequestrum within the bone (Fig. 3). With preliminary diagnosis of chronic osteomyelitis (pyogenic/tubercular/fungal/parasitic), open biopsy and wound debridement was planned. A formal dorsal approach to the first metatarsal was employed. The medullary cavity was found to be filled with caseous material with thinning of the overlying cortex (Fig. 4). The cavity was thoroughly curetted, sinus tracts were excised and the samples were sent for histopathological and microbiological work-up (Table 1). Under the microscope, extensive areas of caseous necrosis surrounded by lymphocytes and epitheloid cells were observed, which is typical of tubercular pathology (Fig. 5). He was started on an anti-tubercular regime comprising of four drugs (Isoniazid, Rifampicin, Pyrazinamide and Ethambutol) daily for 2 months followed by two drugs (Isoniazid and Rifampicin) daily for 10 months. Patient was given a below knee slab support and advised non-weight-bearing walking for 6 weeks, followed by partial weight bearing with walking boot for another 6 weeks. Patient is currently in the 10-month follow-up of 12 months planned treatment with healed sinuses and no fresh complaints.Table 1:


An isolated case of first metatarsal tuberculosis.

Madi S, Naik M, Vijayan S, Rao S - Oxf Med Case Reports (2015)

Plain X-rays (antero-posterior and oblique views) of right foot showing an expansile osteolytic lesion (arrow pointing) with thinning of overlying cortex (arrow heads) of the first metatarsal.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664920&req=5

OMV021F2: Plain X-rays (antero-posterior and oblique views) of right foot showing an expansile osteolytic lesion (arrow pointing) with thinning of overlying cortex (arrow heads) of the first metatarsal.
Mentions: A 19-year-old boy presented to our foot and ankle clinic with pain and wound over right foot for past 1 year. There was ‘watery’ discharge coming from the wound on and off which started spontaneously and subsided by taking antibiotics. There was no history of trauma or any constitutional symptoms. On examination, there were five active discharging sinuses over dorsum of right foot all clustered around first and second ray (Fig. 1). All serological parameters were within normal limits (Table 1) and chest X-ray was also apparently normal. X-ray of foot revealed an expansile osteolytic lesion of the first metatarsal shaft with cortical thinning (Fig. 2). MRI of foot revealed a lytic lesion measuring 26 × 22 mm involving the head, proximal shaft and base of first metatarsal and a sequestrum within the bone (Fig. 3). With preliminary diagnosis of chronic osteomyelitis (pyogenic/tubercular/fungal/parasitic), open biopsy and wound debridement was planned. A formal dorsal approach to the first metatarsal was employed. The medullary cavity was found to be filled with caseous material with thinning of the overlying cortex (Fig. 4). The cavity was thoroughly curetted, sinus tracts were excised and the samples were sent for histopathological and microbiological work-up (Table 1). Under the microscope, extensive areas of caseous necrosis surrounded by lymphocytes and epitheloid cells were observed, which is typical of tubercular pathology (Fig. 5). He was started on an anti-tubercular regime comprising of four drugs (Isoniazid, Rifampicin, Pyrazinamide and Ethambutol) daily for 2 months followed by two drugs (Isoniazid and Rifampicin) daily for 10 months. Patient was given a below knee slab support and advised non-weight-bearing walking for 6 weeks, followed by partial weight bearing with walking boot for another 6 weeks. Patient is currently in the 10-month follow-up of 12 months planned treatment with healed sinuses and no fresh complaints.Table 1:

Bottom Line: An apparently healthy adolescent presented to us with multiple discharging sinuses from his right foot for the past 1 year.All serological parameters were within normal limits.X-ray picture revealed an expansile osteolytic lesion of first metatarsal.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedics , Kasturba Medical College, Manipal University , Udupi, Karnataka , India.

ABSTRACT
An apparently healthy adolescent presented to us with multiple discharging sinuses from his right foot for the past 1 year. All serological parameters were within normal limits. X-ray picture revealed an expansile osteolytic lesion of first metatarsal. Tissue biopsy and PCR confirmed it be of tubercular etiology. The incidence of isolated occurrence of metatarsal tuberculosis is very rare and the diagnostic dilemma it brings about is briefly discussed in the following report.

No MeSH data available.


Related in: MedlinePlus