Tuberculosis of Ankle Joint – rare case reports

Few cases of ankle tuberculosis have been reported in the literature. We describe two cases of tuberculosis of ankle presented to Orthopaedics OPD at Rajindra Hospital, Patiala. Case one was a 34 year male with complain of swelling of the left ankle since 3 years and a discharging sinus at the tip of the old healed scar on the left ankle for 6 months. The patient was an old case of Pulmonary Tuberculosis treated with anti-tubercular therapy 6 years back. On laboratory evaluation, CBC, ESR and CRP were normal. Ankle X-Ray showed a lytic lesion in both malleoli. The patient was admitted and debridement of the left ankle was done, and the tissue specimen CB-NAAT was positive. The patient was subsequently put on anti-tubercular therapy for 11 months. His follow-up visits were uneventful. Case two was a 31 old year female presented to us with complaint of pain at right ankle since 5 months. Pain was followed by swelling which progressed over a period of time of one month. MRI was done which showed bone defect with erosions Tissue sample were sent for histopathological examination and CBNAAT.CBNAAT result came to be positive. Patient was put on ATT. Patient improved after ATT. Ankle TB is a rare entity ,must be considered in the differential diagnosis of a swelling of the foot and ankle., requiring a high index of suspicion. As the disease is progressive and promotes degenerative changes of the articular cartilage, early identification is critical for successful treatment and to avoid permanent functional disability.