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Diagnostic dilemma of tuberculosis in the foot and ankle

Authors
 Woo Jin Choi  ;  Seung Hwan Han  ;  Jong Hwan Joo  ;  Bom Soo Kim  ;  Jin Woo Lee 
Citation
 Foot & Ankle International, Vol.29(7) : 711-715, 2008 
Journal Title
 Foot & Ankle International 
ISSN
 1071-1007 
Issue Date
2008
MeSH
Adolescent ; Adult ; Aged ; Ankle* ; Child ; Child, Preschool ; Diagnosis, Differential ; Female ; Foot* ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Polymerase Chain Reaction ; Tomography, X-Ray Computed ; Treatment Outcome ; Tuberculosis, Osteoarticular/diagnosis* ; Tuberculosis, Osteoarticular/therapy
Keywords
Foot ; Ankle ; Tuberculosis
Abstract
BACKGROUND: Isolated involvement of bone in tuberculous infection is uncommon, and the variable clinical and radiological features may mimic pyogenic osteomyelitis, bone tumor or other inflammatory and neoplastic processes of the synovium. We have reported our experiences with the diagnosis of tuberculosis infection in the ankle and foot with the hope of providing sufficient information about these cases to lead to early diagnosis. MATERIALS AND METHODS: We treated 15 patients with tuberculosis involving the foot and ankle between 1995 and 2005. They were followed for a minimum of 24 months, and the average duration of symptoms was 23 months. All patients underwent a physical examination, routine laboratory tests, plain radiographs, and a biopsy of the infection site. MRI studies were performed in 10 patients and a CT scan was done in one patient. RESULTS: The lesions were located in the forefoot (2), midfoot (3) and ankle (10). From the imaging studies, the presumptive preoperative diagnoses were tuberculous osteomyelitis (7), pyogenic osteomyelitis (4), pigmented villonodular synovitis (2), amyloidosis (1), and avascular necrosis of the talus (1). These diagnoses were verified by granulomatous inflammation with or without caseous necrosis on histology and tubercle bacilli were cultured in four cases. In three cases the diagnosis was made by polymerase chain reaction (PCR). CONCLUSION: When a patient presents with a localized, painful swelling and a persistent draining sinus of the foot and ankle, tuberculosis should be considered in the differential diagnosis. Additionally, we highly recommend taking a biopsy of the site of suspected infection because an early diagnosis is the key to successful treatment.
Full Text
http://fai.sagepub.com/content/29/7/711.abstract
DOI
10.3113/FAI.2008.0711
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Bom Soo(김범수)
Lee, Jin Woo(이진우) ORCID logo https://orcid.org/0000-0002-0293-9017
Choi, Woo Jin(최우진)
Han, Seung Hwan(한승환) ORCID logo https://orcid.org/0000-0002-7975-6067
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/106204
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