title: Isolated tuberculosis of the calcaneum in a constitutionally well patient.
abstract: A 66-year-old Caucasian man presented with a 9-month history of a painful left heel with associated soft tissue swelling. Pitting oedema was present to the upper shin. Plain radiograph showed a sclerotic calcaneum with lucent patches and the CT scan revealed bony destruction at the posterosuperior aspect of the calcaneus with a moth-eaten appearance. To obtain a more definitive diagnosis, the patient underwent a CT-guided biopsy, which showed caseating granulomatous inflammation strongly suggestive of Mycobacterium infection. A Ziehl-Neilson stain did not show any microorganisms. Microbiology confirmed the presence of Staphylococcus aureas. A diagnosis of tuberculosis with concomitant Staphylococcus superinfection was made based on the histology and clinical context. The patient was treated with curettage and cementing of the lesion in order to debride the infected tissue and provide structural support to the bone. A 9-month course of quadruple antituberculous therapy was also initiated.
authors.affiliation: King's College Hospital, London, UK.
authors.forename: Zara
authors.initials: Z
authors.lastname: Hayat
authors.affiliation: Bone Tumour Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
authors.forename: Sujith
authors.initials: S
authors.lastname: Konan
authors.affiliation: Bone Tumour Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
authors.forename: André
authors.initials: A
authors.lastname: Olivier
authors.affiliation: Bone Tumour Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
authors.forename: Tim W R
authors.initials: TW
authors.lastname: Briggs
mesh_terms: D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D001706:Biopsy; D001843:Bone Cements / Q000627:therapeutic use; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000473:pathology; D003475:Curettage; D003937:Diagnosis, Differential; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D015163:Superinfection / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D014394:Tuberculosis, Osteoarticular / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery
chemical_list: D000995:Antitubercular Agents; D001843:Bone Cements