Unexpected case of ankle tuberculosis in a young professionals leading to delay in diagnosis

We report a case of a 38 year-old engineer presented with left ankle pain for 2 years and initially treated as gouty arthritis because of high serum uric acid. A year later his left ankle become swollen and plain radiograph showed soft tissue swelling around the ankle with normal articular surface a...

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Main Authors:	Mohd Yusof, Nazri, Zakaria@Mohamad, Zamzuri, How, Soon Hin
Format:	Conference or Workshop Item
Language:	English English English
Published:	2015
Subjects:	RD701 Orthopedics
Online Access:	http://irep.iium.edu.my/44822/ http://irep.iium.edu.my/44822/ http://irep.iium.edu.my/44822/2/dr_nazri_cerificate.pdf http://irep.iium.edu.my/44822/7/Unexpected_case_of_ankle_tuberculosis.pdf http://irep.iium.edu.my/44822/10/Final_Programme_Guangzhou_09.17-highlight-p109.pdf

id	iium-44822
recordtype	eprints
spelling	iium-448222015-10-07T03:09:16Z http://irep.iium.edu.my/44822/ Unexpected case of ankle tuberculosis in a young professionals leading to delay in diagnosis Mohd Yusof, Nazri Zakaria@Mohamad, Zamzuri How, Soon Hin RD701 Orthopedics We report a case of a 38 year-old engineer presented with left ankle pain for 2 years and initially treated as gouty arthritis because of high serum uric acid. A year later his left ankle become swollen and plain radiograph showed soft tissue swelling around the ankle with normal articular surface and bone. An MRI investigation reported as gouty arthritis of ankle with tophi. While on treatment for gouty arthritis, he developed pus discharge from the swelling. The ankle pain also worsen and he was unable to weight bear on the affected leg. An incision and drainage shown pus from the ankle joint which grew pseudomonas aeruginosa. He was treated with intravenous followed by oral ciprofloxacin 250 mg bd. However his condition does not improved and a month after antibiotic treatment a repeated radiograph shows narrowing of joint space with irregular cortical destruction, osteopenic bone . suggestive of worsening of his septic arthritis. During this period he deny of having any fever, cough or night sweats. However he did notice some loss of weight and loss of appetite. He has worked in Africa and Russia before in petroleum industry. After 4 months of antibiotic and no sign of improvement, a biopsy and repeat culture was taken from the ankle which reveal tuberculous arthritis and positive for AFB culture. A plain chest radiograph revealed miliary tuberculosis picture. He was started on a anti TB treatment and the wound healed after a few weeks. After 4 months of treatment he was able to walk without support with reduce ankle range of motion. This case illustrate that the diagnosis was delay because tuberculosis was not suspected in a young professionals with ankle pain and elevated serum uric acid level. Further delay in diagnosis because MRI report also suggestive of gouty tophi and the pus culture and sensitivity grew pseudomonas aeruginosa. 2015 Conference or Workshop Item PeerReviewed application/pdf en http://irep.iium.edu.my/44822/2/dr_nazri_cerificate.pdf application/pdf en http://irep.iium.edu.my/44822/7/Unexpected_case_of_ankle_tuberculosis.pdf application/pdf en http://irep.iium.edu.my/44822/10/Final_Programme_Guangzhou_09.17-highlight-p109.pdf Mohd Yusof, Nazri and Zakaria@Mohamad, Zamzuri and How, Soon Hin (2015) Unexpected case of ankle tuberculosis in a young professionals leading to delay in diagnosis. In: 36th SICOT Orthopaedic World Congress, 17-19 sept 2015, Baiyun International Convention Centre, Guangzhou, China. (Unpublished) http://www.sicot.org/guangzhou
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English English English
topic	RD701 Orthopedics
spellingShingle	RD701 Orthopedics Mohd Yusof, Nazri Zakaria@Mohamad, Zamzuri How, Soon Hin Unexpected case of ankle tuberculosis in a young professionals leading to delay in diagnosis
description	We report a case of a 38 year-old engineer presented with left ankle pain for 2 years and initially treated as gouty arthritis because of high serum uric acid. A year later his left ankle become swollen and plain radiograph showed soft tissue swelling around the ankle with normal articular surface and bone. An MRI investigation reported as gouty arthritis of ankle with tophi. While on treatment for gouty arthritis, he developed pus discharge from the swelling. The ankle pain also worsen and he was unable to weight bear on the affected leg. An incision and drainage shown pus from the ankle joint which grew pseudomonas aeruginosa. He was treated with intravenous followed by oral ciprofloxacin 250 mg bd. However his condition does not improved and a month after antibiotic treatment a repeated radiograph shows narrowing of joint space with irregular cortical destruction, osteopenic bone . suggestive of worsening of his septic arthritis. During this period he deny of having any fever, cough or night sweats. However he did notice some loss of weight and loss of appetite. He has worked in Africa and Russia before in petroleum industry. After 4 months of antibiotic and no sign of improvement, a biopsy and repeat culture was taken from the ankle which reveal tuberculous arthritis and positive for AFB culture. A plain chest radiograph revealed miliary tuberculosis picture. He was started on a anti TB treatment and the wound healed after a few weeks. After 4 months of treatment he was able to walk without support with reduce ankle range of motion. This case illustrate that the diagnosis was delay because tuberculosis was not suspected in a young professionals with ankle pain and elevated serum uric acid level. Further delay in diagnosis because MRI report also suggestive of gouty tophi and the pus culture and sensitivity grew pseudomonas aeruginosa.
format	Conference or Workshop Item
author	Mohd Yusof, Nazri Zakaria@Mohamad, Zamzuri How, Soon Hin
author_facet	Mohd Yusof, Nazri Zakaria@Mohamad, Zamzuri How, Soon Hin
author_sort	Mohd Yusof, Nazri
title	Unexpected case of ankle tuberculosis in a young professionals leading to delay in diagnosis
title_short	Unexpected case of ankle tuberculosis in a young professionals leading to delay in diagnosis
title_full	Unexpected case of ankle tuberculosis in a young professionals leading to delay in diagnosis
title_fullStr	Unexpected case of ankle tuberculosis in a young professionals leading to delay in diagnosis
title_full_unstemmed	Unexpected case of ankle tuberculosis in a young professionals leading to delay in diagnosis
title_sort	unexpected case of ankle tuberculosis in a young professionals leading to delay in diagnosis
publishDate	2015
url	http://irep.iium.edu.my/44822/ http://irep.iium.edu.my/44822/ http://irep.iium.edu.my/44822/2/dr_nazri_cerificate.pdf http://irep.iium.edu.my/44822/7/Unexpected_case_of_ankle_tuberculosis.pdf http://irep.iium.edu.my/44822/10/Final_Programme_Guangzhou_09.17-highlight-p109.pdf
first_indexed	2023-09-18T21:03:44Z
last_indexed	2023-09-18T21:03:44Z
_version_	1777410794294607872

Unexpected case of ankle tuberculosis in a young professionals leading to delay in diagnosis

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