Journal of Kerman University of Medical Sciences

Isolated Calcaneal Tuberculosis: A Case Report

Document Type : Case Report

Authors

Mohammad Sajjad Mirhoseini 1
Leila Sadati 2
Rana Abjar 2

1 Department of Orthopedics, Madani Clinical Research Development Unit, Shahid Madani Hospital, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran

2 Department of Operating Room, School of Paramedical Sciences, Alborz University of Medical Sciences, Karaj, Iran

https://doi.org/10.34172/jkmu.4033
Abstract
Introduction: Calcaneal Tuberculosis (TB) is a rare disease that can be easily misdiagnosed due to its nonspecific features and low clinical suspicion.
Case Report: This report described an 85-year-old woman who presented to the Emergency Department with foot pain and swell­ing following a fall. Initial investigations revealed a calcaneal fracture requiring surgery, but the patient declined the intervention. She was discharged with a splint and re-presented after one year with persistent pain, swelling, and a draining skin wound over her right ankle. Further investigations confirmed the diagnosis of calcaneal TB. The patient responded well to a four-drug regimen (Isoniazid, Rifampin, Ethambutol, and Pyrazinamide) for three months, followed by a two-drug regimen (Isoniazid and Rifampin) for 15 months.
Conclusion: This case highlights the importance of considering tuberculosis in patients with bone lesions, even without typical symptoms. Delayed treatment may lead to complications such as abscesses and fistulae, potentially causing disability.

Highlights

Mohammad Sajjad Mirhoseini (Google Scholar)  (PubMed)

Leila Sadati (Google Scholar)  (PubMed)

Rana Abjar (Google Scholar)  (PubMed)

Keywords

Tuberculosis
Calcaneus
Calcaneal Tuberculosis
Bone Tuberculosis
Subjects
  1. World Health Organization (WHO). Global Tuberculosis Report 2019. WHO; 2019. Available from: https://www.who. int/tb/publications/global_report/en/. Accessed October 28, 2019.
  2. Elbouhy MS, Abdelhalim HA, Boshra MS. Prevalence and diagnosis of extrapulmonary tuberculosis in Assuit Chest Hospital. Egypt J Chest Dis Tuberc 2020;69(1):12-5. doi:10.4103/ejcdt.ejcdt_22_19
  3. Gardam M, Lim S. Mycobacterial osteomyelitis and arthritis. Infect Dis Clin North Am 2005;19(4):819-30. doi:10.1016/j. idc.2005.07.008
  4. Dhillon MS, Nagi ON. Tuberculosis of the foot and ankle. Clin Orthop Relat Res 2002(398):107-13. doi:10.1097/00003086- 200205000-00015
  5. Dhillon MS, Sharma S, Gill SS, Nagi ON. Tuberculosis of bones and joints of the foot: an analysis of 22 cases. Foot Ankle 1993;14(9):505-13. doi:10.1177/107110079301400904
  6. Yadav AK, Prasanna Kumar GS, Akshay KS, Harsoor A, Mane A, Mishra S. Tuberculosis of calcaneus - a case report and review of literature. J Orthop Case Rep 2020;10(5):24-6. doi:10.13107/ jocr.2020.v10.i05.1822
  7. Tuli SM. Tuberculosis of the Skeletal System. JP Medical Ltd; 2016.
  8. Martini M, Adjrad A. Tuberculosis of the ankle and foot joint. In: Tuberculosis of the Bones and Joint. Berlin: Springer Verlag; 1988.
  9. Karanis G, Karanis P. Tuberculosis: epidemiology and global impact, including extrapulmonary tuberculosis manifestation with emphasis on skeletal tuberculosis and a rare example of shoulder tuberculosis from Tibetan Plateau area. In: Encyclopedia of Environmental Health. Elsevier; 2019. p. 135- 60. doi:10.1016/b978-0-12-409548-9.11244-8
  10. Messner RP. Arthritis due to mycobacteria, fungi and parasites. In: Arthritis and Allied Conditions: A Textbook of Rheumatology. Lippincott Williams & Wilkins; 1993. p. 2035-46.
  11. Velayati AA, Farnia P, Mozafari M, Malekshahian D, Farahbod AM, Seif S, et al. Identification and genotyping of Mycobacterium tuberculosis isolated from water and soil samples of a metropolitan city. Chest 2015;147(4):1094-102. doi:10.1378/chest.14-0960
  12. Pigrau-Serrallach C, Rodríguez-Pardo D. Bone and joint tuberculosis. Eur Spine J 2013;22(Suppl 4):556-66. doi:10.1007/ s00586-012-2331-y
  13. Mariconda M, Cozzolino A, Attingenti P, Cozzolino F, Milano C. Osteoarticular tuberculosis in a developed country. J Infect 2007;54(4):375-80. doi:10.1016/j.jinf.2006.06.006
  14. Agarwal S, Caplivski D, Bottone EJ. Disseminated tuberculosis presenting with finger swelling in a patient with tuberculous osteomyelitis: a case report. Ann Clin Microbiol Antimicrob 2005;4:18. doi:10.1186/1476-0711-4-18
  15. Berney S, Goldstein M, Bishko F. Clinical and diagnostic features of tuberculous arthritis. Am J Med 1972;53(1):36-42. doi:10.1016/0002-9343(72)90113-1
  16. Wallace R, Cohen AS. Tuberculous arthritis: a report of two cases with review of biopsy and synovial fluid findings. Am J Med 1976;61(2):277-82. doi:10.1016/0002-9343(76)90177-7
  17. Gyawali B, Sharma BD, Kayastha N, Joshi A. Tuberculosis mimicking bone tumor. Med J Shree Birendra Hosp 2012;11(1):49-51.
  18. Bush DC, Schneider LH. Tuberculosis of the hand and wrist. J Hand Surg Am 1984;9(3):391-8. doi:10.1016/s0363- 5023(84)80230-0
  19. Arthanari S, Yusuf S, Nisar M. Tuberculosis of the knee complicating seronegative arthritis. J Rheumatol 2008;35(6):1227-8.
  20. Chen SC, Chen KT. Updated diagnosis and management of osteoarticular tuberculosis. J Emerg Med Trauma Surg Care 2014;1:1-7. doi:10.24966/ets-8798/100002
  21. Chakravorty S, Tyagi JS. Novel multipurpose methodology for detection of mycobacteria in pulmonary and extrapulmonary specimens by smear microscopy, culture, and PCR. J Clin Microbiol 2005;43(6):2697-702. doi:10.1128/jcm.43.6.2697- 2702.2005
  22. Wiratnaya IGE, Susila I, Sindhughosa DA. Tuberculous osteomyelitis mimicking a lytic bone tumor: report of two cases and literature review. Rev Bras Ortop (Sao Paulo) 2019;54(6):731-5. doi:10.1016/j.rboe.2017.11.015
  23. Wadhawan A, Mandal M, Gupta S, Nischal N, Arora S. Isolated tuberculous osteomyelitis of calcaneus in an immune-competent adult patient with literature review: a case report. JBJS Case Connect 2025;15(1):e24.00413. doi:10.2106/jbjs. Cc.24.00413
  24. Jadawala VH, Deshpande SV, Salwan A, Wamborikar H, Randad R, Jadawala R. Tuberculous osteomyelitis of calcaneum: a rare case. Cureus 2024;16(10): e70659. doi:10.7759/cureus.70659

 

Journal of Kerman University of Medical Sciences
Volume 33
Pages 1-4

Home

Editorial Board

Guide for Authors

Submit Manuscript

Guide for Reviewers

Contact Us