A Simple Approach for Diagnosis of Chronic Tuberculous Osteomyelitis: A Case Report

Osteomyelitis is a secondary complication in 1% to 3% of patients with pulmonary tuberculosis (TB). Definite diagnosis of TB-associated osteomyelitis is challenging for clinicians, as biopsies of deep osteoarticular tissues are necessary.
We present the case of a 50-year-old man, admitted to Imam Khomeini hospital, Tehran, Iran in March 2014. According to his self-report, he had a chronic ulcer on his left foot since September 2012. In physical examinations, there was a painful sinus tract orifice (2 × 2 cm) on the left medial malleolus. Magnetic resonance imaging (MRI) of the foot revealed osteomyelitis in the left ankle. Two biopsies were taken from the wound edge, and Mycobacterium tuberculosis was detected via polymerase chain reaction (PCR) assay.
Today, in the diagnosis of TB-associated osteomyelitis, it is a common practice to obtain 3 osteoarticular tissue biopsies for microbiological evaluation, PCR analysis, and histopathological assessment. We suspect that biopsies from the edge of the sinus tract orifice may help diagnose TB osteomyelitis.