Accepted Manuscript Title: “Isolated tuberculous osteomyelitis of the talonavicular joint without pulmonary involvement–a rare case report” Author: Wystan Chevannes Arman Memarzadeh Chandra Pasapula PII: DOI: Reference:
S0958-2592(14)00131-X http://dx.doi.org/doi:10.1016/j.foot.2014.11.005 YFOOT 1354
To appear in:
The Foot
Received date: Accepted date:
3-11-2014 28-11-2014
Please cite this article as: Chevannes W, Memarzadeh A, Pasapula C, “Isolated tuberculous osteomyelitis of the talonavicular joint without pulmonary involvementndasha rare case report”, The Foot (2014), http://dx.doi.org/10.1016/j.foot.2014.11.005 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
“Isolated tuberculous osteomyelitis of the talonavicular joint without pulmonary involvement – a rare case report”
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Wystan Chevannes, Arman Memarzadeh, Chandra Pasapula Authors: Wystan Chevannes (First Author) Specialty Registrar, Orthopaedic Department, Queen Elizabeth Hospital, Kings Lynn, UK, PE30 4ET
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“Isolated tuberculous osteomyelitis of the talonavicular joint without pulmonary involvement – a rare case report”
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Arman Memarzadeh
(Corresponding Author) Specialty Registrar, Orthopaedic Department, Queen Elizabeth Hospital, Kings Lynn, UK, PE30 4ET
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Chandra Pasapula
Foot and Ankle Consultant, Orthopaedic Department, Queen Elizabeth Hospital, Kings Lynn, UK, PE30 4ET
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Corresponding Author: Arman Memarzadeh 125 Blinco Grove, Cambridge, UK, CB1 7TX Tel: +44 (0) 7985 430 103 Email:
[email protected] Manuscript word count: 1,698 Figures: 4
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“Isolated tuberculous osteomyelitis of the talonavicular joint without pulmonary involvement – a rare case report”
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Isolated tuberculous osteomyelitis of the talonavicular joint
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without pulmonary involvement – a rare case report
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Abstract
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Tuberculosis is one of the leading causes of death worldwide amongst curable diseases. It is estimated that one‐third of the world's population has been diagnosed with tuberculosis infection.1 The prevalence is on the rise with an estimated 9.4 million new cases per year worldwide.1 Tuberculosis most commonly presents with pulmonary involvement. However, approximately 23‐30% of patients found to be infected with tuberculosis have extrapulmonary symptoms.2 Of those, only 1‐3% have been found to have osseous disease. Skeletal involvement with a primary focus of tuberculosis usually affects major weight‐bearing joints such as the hip and knee. Tuberculosis infections of the foot and ankle are very rare, accounting for 1% of all tuberculosis infections.2‐4 Difficulties arise in the timing of diagnosis, patient compliance of therapy and awareness of the less obvious presenting symptoms. Musculoskeletal tuberculosis, although rare, can be a problem. Its uncommon site, non‐specific presenting symptoms and its ability to mimic numerous disorders make it more difficult to formulate a definitive diagnosis and, in turn, leads to therapeutic delays.5‐7 It is for this reason that we report this case in an effort to promote awareness.
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Case Report
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We report a case of a 74 year old lady of Sri Lankan origin who presented with a three month history of progressive pain and swelling in her right foot. She reported pain up to a severity of 10/10 and increasing night pain. On further questioning it emerged that she had been suffering from intermittent pain and swelling for over a year. She had also sustained minor trauma to her foot five years prior, but there was never any penetrating injury. There was no history of any recent infection, temperature, malaise, synovitic disorders or trauma to the foot. Having moved to the UK from Sri Lanka nine years ago, she denied any previous chest symptoms or any family history of tuberculosis. Past medical history was of type II diabetes mellitus with associated peripheral neuropathy and hypertension. On examination there was swelling of the right midfoot with restricted subtalar motion. There no was no perception of 256Hz tuning fork and Semmes‐ Weinstein monofilament testing revealed no sensation. The working diagnosis was one of a Charcot joint. She continued to experience severe pain, leading to multiple presentations to the Emergency Department. Blood tests revealed a white cell count of 8.0 x 109/L (4‐10), an ESR of 60mm/hour (150‐400) and a CRP