Tuberculosis of the Ankle Joint: An Uncommon Presentation of Skeletal Tuberculosis

Skeletal tuberculosis constitutes 1 to 3% of extra pulmonary tuberculosis, and involvement of foot bones is rare. It is therefore unlikely that diagnosis of tuberculosis of the ankle joint will be rapidly made in a healthy looking patient who presents with difficulty with walking, right ankle pain and swelling and fever a week prior to presentation.

We present a case of tuberculosis of the right ankle joint which was difficult to diagnose until histopathology of the synovial biopsy specimen showed features of infection with Mycobacterium tuberculosis and medical treatment with anti-tubercle bacilli agents completely resolved symptoms within two weeks.

Fever, joint pain and swelling in any patient should attract the suspicion of tuberculosis of that joint irrespective of the past medical history. The main stay of diagnosis is histopathology of the synovial biopsy. Joint aspirations should not only be for microscopy, culture and sensitivity; cytology and culture for tubercle bacilli should also be done whenever possible.  CT scan and MRI of the affected joint may provide additional information particularly in early cases but requires further evaluation.

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