Tuberculous Osteomyelitis of the First Metatarsophalangeal Joint Misdiagnosed as Gouty Arthritis.
10.4078/jrd.2016.23.5.311
- Author:
Jin Seon JEONG
1
;
Ji Hyun KIM
;
Sung Hyun PARK
;
Jae Hoon JEONG
;
Young Joon RYU
;
Ki Won MOON
Author Information
1. Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea. kiwonmoon@kangwon.ac.kr
- Publication Type:Case Report
- Keywords:
Tuberculosis;
Osteomyelitis;
Metatarsophalangeal joint;
Foot;
Gout
- MeSH:
Arthritis, Gouty*;
Biopsy;
Bone Cysts;
C-Reactive Protein;
Early Diagnosis;
Erythema;
Foot;
Gout;
Inflammation;
Joints;
Magnetic Resonance Imaging;
Metatarsophalangeal Joint*;
Mycobacterium tuberculosis;
Necrosis;
Osteomyelitis*;
Polymerase Chain Reaction;
Tuberculosis;
Ulcer;
Uric Acid
- From:Journal of Rheumatic Diseases
2016;23(5):311-315
- CountryRepublic of Korea
- Language:English
-
Abstract:
A-43-year-old man visited our clinic due to pain and swelling of his left first metatarsophalangeal (MTP) joint since 6-months ago. He was diagnosed as gouty arthritis at private clinic and took hypouricemic agent, but he had progressive pain and swelling. There was swelling, erythema and tenderness and ulceration at base of the left first MTP joint. His laboratory results showed elevated C-reactive protein and normal serum uric acid level. The plain radiograph of foot showed bone destruction of left first MTP joint. MRI revealed joint space narrowing, soft tissue swelling and subchondral cyst. He underwent excisional biopsy and histology demonstrated chronic granulomatous inflammation with caseation necrosis. Tissue polymerase chain reaction for mycobacterium tuberculosis was positive. He was diagnosed as tuberculous osteomyelitis. He started on quadruple anti-tuberculous therapy and his symptom was improved. Early diagnosis and anti-tuberculosis therapy could lead to improve outcomes.
