Clin Pain.  2019 Dec;18(2):102-106. 10.35827/cp.2019.18.2.102.

Calcaneal Osteomyelitis Presenting as a Paradoxical Reaction during Treatment of Multidrug-Resistant Tuberculosis

• Han YH
• Lee CH
• Bae MJ
• Hwang K

• KMID: 2470356
• DOI: http://doi.org/10.35827/cp.2019.18.2.102

Abstract

Tuberculosis in the foot progresses gradually; thus, diagnosis is usually delayed, and early treatment is rarely provided. If osteomyelitis occurs due to delayed diagnosis and treatment, surgical treatment should be considered. We report the case of a 46-year-old man with osteomyelitis of the calcaneus who was diagnosed with multidrug-resistant pulmonary tuberculosis and he was treated with anti-tuberculosis drugs. Bilateral adrenal masses, abscess of both testes and a small wound in the left plantar heel were observed. Both adrenal masses and abscess were regarded as paradoxical reaction of anti-tuberculosis treatment. After 1 month, he developed a pain in the left plantar heel that was compatible with calcaneal osteomyelitis in radiological features. He underwent right orchiectomy for right scrotal abscess aggravation and surgical treatment for left calcaneal osteomyelitis. Mycobacterium tuberculosis was confirmed by polymerase chain reaction. The patient was immobilized by cast for 8 weeks and the heel pain gradually improved.

Keyword

Tuberculous osteomyelitis; Heel pain; Calcaneal tuberculosis

MeSH Terms

Abscess
Calcaneus
Delayed Diagnosis
Diagnosis
Foot
Heel
Humans
Middle Aged
Mycobacterium tuberculosis
Orchiectomy
Osteomyelitis*
Polymerase Chain Reaction
Testis
Tuberculosis
Tuberculosis, Multidrug-Resistant*
Tuberculosis, Pulmonary
Wounds and Injuries