Tuberculous osteomyelitis of the midfoot: a case report.
BACKGROUND
The prevalence of tuberculosis is increasing and musculoskeletal tuberculosis, although currently rare, may become an important problem.


METHODS
We report the case of a 20-year-old Somalian man, who presented with an inversion injury to his ankle. When further history was taken, it transpired that he had sustained trauma to his ankle in Somalia 4 years previously, complicated by a non-healing wound. His foot pain and swelling had been present ever since. Diagnosis of tuberculosis was made by bone biopsy, histology of which demonstrated caseating granulomas. Tissue culture yielded growth of tuberculous bacilli. The patient made a full recovery on anti-tuberculous treatment.


CONCLUSIONS
Musculoskeletal tuberculosis can be difficult to diagnose as only about one third of patients have respiratory symptoms. Synovial fluid aspirate is relatively unlikely to lead to definitive diagnosis, and a bone biopsy should always be taken for culture and histological examination.
Flint
Julia D
JD
Department of Rheumatology, City Hospital Birmingham UK. juliaflint@cantab.net
Saravana
Shanmugam
S