title: Multifocal bilateral metatarsal tuberculosis: a rare presentation.
abstract: Tuberculosis, or phthisis (consumption) as it was popularly known in the Greek era, has been endemic in Southeast Asia and Sub-Saharan Africa; however, the human immunodeficiency virus epidemic has seen the re-emergence of this disease in the areas in which it was not very commonly reported. With this, the need for understanding and treatment of rare presentations of tuberculosis has become of paramount importance to achieve the World Health Organization millennium goal of a "reversal of incidence by 2015." Foot involvement has been reported in 0.1% to 0.3% of extrapulmonary cases. Multifocal lesions have an incidence of <10% in osteoarticular tuberculosis. Bilateral feet involvement in multifocal tuberculosis has not yet been reported in either children or adults in published studies. We report a case of tuberculosis with lesions in the bilateral metatarsals, the occurrence of which is very rare. The diagnosis was mainly histopathologic owing to the paucibacillary nature of the disease. Early identification and treatment with antitubercular drugs will normally result in a good cosmetic and functional result.
authors.affiliation: Surgeon, Department of Orthopaedics, Lady Hardinge Medical College, Shaheed Bhagat Singh Marg, New Delhi, India. Electronic address: dr_vipulvijay@yahoo.com.
authors.forename: Vipul
authors.initials: V
authors.lastname: Vijay
authors.affiliation: Professor, Department of Orthopaedics, Lady Hardinge Medical College, Shaheed Bhagat Singh Marg, New Delhi, India.
authors.forename: Alok
authors.initials: A
authors.lastname: Sud
authors.affiliation: Professor, Department of Orthopaedics, Lady Hardinge Medical College, Shaheed Bhagat Singh Marg, New Delhi, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Mehtani
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008682:Metatarsal Bones / Q000382:microbiology* / Q000601:surgery; D014394:Tuberculosis, Osteoarticular / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery
chemical_list: D000995:Antitubercular Agents
keywords: Mycobacterium paucibacillary; acid fast bacillus; bone; chronic osteomyelitis; human immunodeficiency virus; metatarsus