Osteochondritis of the cuboid associated with tuberculosis of adjacent tarsal bones; report of a case.

A Chinese boy, aged six ‘ears, was seen at the Chung Shan Memorial Hospital, Shanghai, on August 12, i947, for discharging sinuses over the left neck, left elbow and dorsum of the left foot. ille sinuses, which had been present for more than a year, began as multiple nodules in the neck, and ruptured. The clinical diagnosis was tuberculosis of the cervical glands, left elbow alld left foot. Radiographs of the left foot showed moderate osteoporosis of the bones, but the cuboid presented disc-like flattening with moderate sclerosis and a sharp outline (Figs. 1 and 2). There was moderate soft tissue swelling with cloudiness of the tarsal region, especially dorsally. The radiographic appearances suggested osteochondritis of the cuboiti, despite the clinical diagnosis of tuberculosis. The patient was seen again nine months later, when he complained of a running nose, cough and fever for three days. The general condition was satisfactory. On clinical examination of the lungs there were wheezy breath sounds in all areas and a few inconstant r#{225}les over the right tipper chest in front. Pulmonary tuberculosis was suspected. The multiple sinuses on the left side of the neck were neither better n r worse, but the condition of the left elbow and ankle seemed improved. A radiograph of the chest showed heavy markings and haziness at the hila, with patchy clouding in both middle and infraciavicular zones and a few calcified opacities ill tile hilar and lower zones, indicative of pulmonary tuberculosis. There were several calcified nodules of medium size throughout the central abdomen. Radiographs of the left foot showed that the cuboid had become larger and thicker, although still somewhat flat, rather sclerotic and sharply outlined (Fig. 3). A tiny piece of bone was seen at its lateral aspect. There were patchy areas of destruction within the third cuneiform bone, suggesting tuberculosis. The other tarsal bones remained osteoporotic, and there was still moderate soft tissue swelling. The right foot showed a normal cuboid (Fig. 4). Radiographs of the left elbow showed moderate erosion of the articular surfaces of the radius and ulna. The left foot was treated by immobilisation in plaster. Six months later, radiographs showed further increase in the size and thickness of the cuboid, which was less dense than before and fairly sharp (Figs. 5 and 6). The tiny bony fragment at the lateral aspect of the cuboid was still present. There was further destruction of the third cuneiform bone, but its outline remained sharp (in appearance not unlike caries sicca of the shoulder). The cuneiforms, cuboid and navicular were more crowded together. Soft tissue swelling and clouding were still evident, but less marked. The left elbow showed further slight destruction. \Vhen last seen on December 28, 1948, the patient’s general condition was good but the cough was not improved. The lesions in the cervical region were healed and the sinuses in the left foot were covered with dry crusts. Comment-There can be little doubt, on the radiographic evidence, that this was a case of osteochondritis of the cuboid. Similarly, from the clinical and radiographic findings and despite lack of bacteriological proof, one can safely regard the other lesions of the left foot, left elbow, neck and chest as tuberculous in nature. Evidence of widespread tuberculosis was further strengthened by the demonstration of calcified mesenteric nodes. It was unfortunate that the patient could not be observed over a longer period.