A Rare Presentation of Osteoarticular Tuberculosis in a Child with Chronic Foot Swelling: A Case Report

Background: Osteoarticular tuberculosis is a rare form of extrapulmonary tuberculosis in children and often presents with nonspecific clinical manifestations that may mimic malignancy or chronic infection. Its insidious onset and often normal initial imaging frequently lead to delayed diagnosis. Objective: To report a rare case of pediatric osteoarticular tuberculosis involving the left dorsal foot that initially mimicked malignancy and highlight the importance of clinical suspicion and histopathological confirmation. Case: A 6-year-old boy presented with progressive swelling of the left dorsal foot since the age of four following minor trauma, accompanied by a chronic wound with purulent discharge despite symptomatic treatment and two prior surgical debridements. The patient had a history of close contact with a parents with tuberculosis and had previously completed Tuberculosis preventive therapy. Physical examination showed a 2 × 2 cm ulcer with yellowish discharge and granulation tissue. Laboratory tests and chest radiography were unremarkable. Computed tomography revealed a destructive heterogeneous lesion suspicious for malignancy. However, histopathological examination revealed granulomatous inflammation with caseous necrosis and multinucleated giant cells, consistent with osteoarticular tuberculosis. The patient was treated with a 12-month anti-tuberculosis regimen (2HRZE/10HR) with close follow-up. Discussion: Osteoarticular tuberculosis accounts for 5–6% of pediatric extrapulmonary TB, with foot and ankle involvement being extremely rare and may resemble chronic infection or malignancy radiologically. Histopathological examination remains essential for definitive diagnosis. Conclusion: Pediatric osteoarticular tuberculosis should be considered in children presenting with chronic monoarticular swelling, particularly in the presence of tuberculosis contact history. Early recognition and comprehensive evaluation are crucial to avoid delayed treatment and long-term complications. comprehensive evaluation are crucial to avoid delayed treatment and long-term complications.