Coexistence of multiple forms of tuberculosis – a delayed diagnosis

Abstract

Introduction Tuberculosis (TB) can be located in any segment of the osteoarticular system, being the most common in the spine, with approximately 50% of cases. In only 10% of the cases of osteoarticular TB the location is multiple; generally, it is monoarticular or located at the level of a single segment of the spine. The diagnosis can be delayed in the early stages due to its varied and hidden presentation and the probability of being confused with other pathologies of the osteoarticular system. Delay in diagnosis can lead to chronic pain, joint destruction and progression to symptomatic bony ankylosis. Case Presentation A 64-year-old man presented with left lower limb, coccyx pain and peri-anal discharge. CT scan of the pelvis showed recto-integumentary perianal fistulous trajectory externalised on the left side of the anus and osteomyelitis. Left ankle CT: Cystic image of approximately 4.2/6/10 cm well-demarcated, with some central microcalcifications, located in the postero-tibial soft parts, communicating with the tibiotalar joint. Conclusion This case highlights the importance of considering TB as a diagnosis if unusual sites are involved.