Navicular and cuneiform tuberculosis: a rare localization of tarsal tuberculosis

Navicular bone and cuneiform were infrequent locations of tarsal tuberculosis. The present study reported an unusual case of navicular and cuneiform tuberculosis who was successfully treated with Streptomycin-loaded bone cement. A 71-year-old Chinese male patient was admitted to our hospital with complaints of swelling and pain at the dorsal aspect of the right foot for 6 months. The patient presented obvious swelling and distension, skin redness and fever as well as an ellipse skin lesion (1.5×1.5 cm) at the dorsal aspect of the right foot. Radiological examination displayed a reduction in right tarsal bone density, trabecular thinning and indistinct joint space but no sequestrum; right lower extremity vascular ultrasound showed atherosclerosis of the lower extremity and a formation of plaque at the right femoral artery; and magnetic resonance imaging (MRI) revealed edematous marrow in the right navicular bone, medial, middle and lateral cuneiform bones. Swear and culture of blood and wound secretions were normal. Debridement of focal lesion and Streptomycin-loaded bone cement implantation were performed. Postoperatively acid-fast staining of lesion sample revealed acid-fast bacilli. The patient received two weeks of antituberculous chemotherapy and obtained a good clinical outcome. In conclusion, the diagnosis of tarsal tuberculosis should be strongly considered the presence of acid-fast bacillus in the lesion smear or culture and a suggestive MRI image. Streptomycin-loaded bone cement implantation following the surgical debridement of focal lesion was an effective treatment for tarsal tuberculosis.