A rare case of osteoarticular tuberculosis and tuberculous osteomyelitis of the left foot without pulmonary involvement

Tuberculosis (TB) of the musculoskeletal system is an uncommon manifestation, accounting for only 1-3% of all TB cases and typically affects the spine and large joints. Isolated TB of the foot is even rarer, comprising less than 10% of osteoarticular TB. Tuberculous osteomyelitis, where the infection is limited to the bone without joint involvement, is an even more uncommon presentation. A 55-year-old male with a history of fall presented with chronic left foot pain and swelling. Initial workup led to a misdiagnosis of Charcot foot. Despite treatment with analgesics and intra-articular platelet-rich plasma injections, symptoms still persisted for several months. MRI revealed inflammation in multiple joints with bone damage (erosions & edema) along with reduced joint space in talonavicular joint and Mycobacterium tuberculosis was identified on interferon gamma release assay. The patient was ultimately diagnosed with diffuse osteoarticular tuberculosis and tuberculous osteomyelitis of the left foot and commenced on anti-tubercular therapy. After few months symptoms were resolved and patient was tested negative for TB. Our case highlights the importance of maintaining a high index of suspicion for osteoarticular tuberculosis, even in the absence of pulmonary involvement, especially in immunocompromised patients like diabetics. This case emphasizes the importance of a multidisciplinary approach for accurate diagnosis and effective management of such challenging presentation.