Tuberculous Arthritis in the Ankle in an Immunocompetent Patient: a Case Report

Osteoarticular tuberculosis comprises 1–3% of tuberculosis (TB) patients. In 50% of cases of osteoarticular TB affects the spine. Other joints, such as the ankle, hip, and knee, are less affected. The diagnosis may be delayed for months due to an indolent course and absence of specific signs. Here we report the case of a 42-year-old immigrant immunocompetent male with tuberculosis osteoarthritis of the ankle. The patient experienced intermittent arthritis episodes affecting the left ankle following a fracture of the calcaneus 4 years prior. Initial therapy with anti-inflammatory drugs and empirical antibiotics did not produce improvement. A histological study following a surgical biopsy of the bone provided the diagnosis of tuberculosis. The patient had no respiratory symptomatology, and the chest X-ray was normal. The patient improves his symptoms by administering antitubercular chemotherapy with isoniazid, rifampicin, pyrazinamide, and ethambutol. The diagnosis of osteoarticular TB requires a high index of suspicion, mainly in immunocompetent patients and in low-incidence countries.