Tuberculosis of Talonavicular Joint Without Pulmonary Involvement in an Indian Child: A Report of a Rare Case

Abstract

Osteoarticular tuberculosis is a rare entity, even in endemic countries. Isolated cases of tuberculosis of the talonavicular joint are sparse. Primary involvement of the talonavicular joint without pulmonary infection with Mycobacterium tuberculosis is rarest of rare. Here, we report a case of primary talonavicular joint tuberculosis without pulmonary involvement in an Indian child. To the best knowledge of the authors, it is the third such case ever reported in a child in the world. The patient presented with complaints of pain and swelling of the right foot. Detailed laboratory work-up backed by radiological investigations helped in establishing the diagnosis. He was managed conservatively with antitubercular chemotherapy with improvement in his symptoms and was transferred out to his native village.

Tuberculosis of the Right Fifth Metatarsal and Fourth Web Space Without Pulmonary Involvement: A Rare Case

“…Tuberculosis is a substantial contributor to morbidity and mortality in underprivileged countries in Asia, Africa, and Europe [1,5]. Mainly, this affects the lungs, and extrapulmonary infections are reported due to hematogenous spread from the lungs [1,9].…”

“…The management of tuberculosis of the metatarsals is predominantly non-surgical and involves the use of anti-tubercular medicines [3,5]. But a surgical approach is taken in cases with intractable disease or as a limb salvage method in patients with deformities in hindfoot joints [3].…”

“…The most commonly involved sites are the spine, hip, knee, and bones of the foot [4]. However, the involvement of small bones in the foot is very rare [5]. Tuberculosis of the foot and ankle accounts for nearly 10% of all osteoarticular tuberculosis [6].…”

Isolated Tuberculosis of the First Metatarsal of the Right Foot Without Pulmonary Involvement: A Rare Case

“…Tuberculosis of the bones and joints is rare and is usually reported in less than 3% of total cases of extrapulmonary tuberculosis [2]. Tuberculosis of the small bones of the foot is an extremely rare condition [8]. The incidence of tuberculosis of the metatarsal is less than 0.5%, with the first and fifth metatarsals being most commonly involved [9,10].…”

“…The diagnosis is extremely challenging [8]. This is mainly due to overlapping clinical features with other musculoskeletal disorders [11].…”