Osteolytic Cystic Lesion of Naviculum: The Great Mimicker

INTRODUCTION: Children show a higher predisposition to the development of extrapulmonary tuberculosis. Osteoarticular tuberculosis, especially in the foot is uncommon therefore it has remained a diagnostic enigma. The non-specific, often indolent, clinical presentation of foot (navicular) tuberculosis, whose low prevalence and low index of suspicion among clinicians may convert a purely osseous lesion into one involving a joint with more local destruction and functional disability. However, prompt diagnosis and treatment of this curable disease remains critical for initiation of proper management, prevention of joint deformity and permanent bone destruction. CASE PRESENTATION: A 6-year-old female child with pain and swelling over the mid-foot was the subject of this study. Clinical, haematological, radiological examination and FNAC was done which revealed it to be of tuberculous pathology. Treatment consisted of anti-tubercular regimen for a period of 15 months. Within 4 months of starting anti tubercular therapy the patient was pain free and fully weight bearing on the affected foot. CONCLUSION: To make a diagnosis of tuberculosis one must consider it as a possibility. Long standing pain and swelling of the midfoot should include TB in the differential diagnosis of destructive osteoarticular lesions. Since the radiological features are non-specific, so a high degree of suspicion is required to avoid permanent articular disability, to obtain a supple, painless and weight bearing foot.