Tuberculosis of the Cuboid Bone: An Unfamiliar Manifestation of a Familiar Disease

Abstract

This report discusses a patient with chronic ankle pain for 2 years. No respiratory symptoms were present, but her father had tuberculosis (TB) when she was four. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated. Empirical antibiotic therapy was initiated. The viral panel test was negative, while the purified protein derivative (PPD) test showed >20 mm induration. Chest radiograph and computed tomography (CT) scan were normal. Ankle radiograph revealed hypodense areas, osteolytic changes, and soft tissue swelling in the cuboid bone. Magnetic resonance imaging (MRI) confirmed soft tissue signal in the cuboid bone. Biopsy showed non-caseating necrotizing granulomatous reaction. The polymerase chain reaction (PCR) and culture confirmed M. tuberculosis infection. Anti-TB treatment was initiated. Skeletal TB in peripheral bones is very rare. Early-stage diagnosis can be challenging due to various potential causes, leading to irreversible complications. Thus, a high index of clinical suspicion should always be maintained. Imaging findings may be suggestive but not confirmative.