ISOLATED CUNEIFORM TUBERCULOSIS A RARE CASE REPORT

Background: Skeletal tuberculosis accounts for 1 to 3% of extra pulmonary tuberculosis of which 10% involve foot and ankle, which is 0.1 to 0.3% of extra pulmonary tuberculosis. Spine is the most common site and involvement of foot is rare for tuberculosis. The bones involved are usually the calcaneum, talus, first metatarsal, navicular and lateral and intermediate cuneiforms. Because of rare occurrence, diagnosis of tuberculosis of foot remains a dilemma especially when confined to a single bone without articular involvement. Material &Method: A 9 year old girl presented to us with swelling, gradual increasing pain in right foot more so on weight bearing from last six months. There was no history of constitutional symptoms or trauma. There was no family history of tuberculosis. On examination there was a swelling on dorsal aspect of right mid foot with tenderness. There was no other positive finding. The x-ray shows a lytic lesion of Lateral cuneiform with sequestrum with normal tarso-metatarsal and inter-tarsal joints of right foot. Routine blood investigations were normal. The lesion was addressed by dorsal approach and curettage biopsy was done. After through curettage, the lesion was packed with cancellous bone grafts. The histopathology confirmed it to be tuberculosis. The Foot -ankle was immobilized by below knee plaster slab for 8 weeks and then patient was gradually mobilized. Result: Patient was followed up for 11/2 year with no signs of recurrence. Conclusion:Isolated tuberculosis of cuneiform bone is a rare occurrence. The curettage and bone grafting gave us excellent result, which is the treatment of choice.