TB osteomyelitis

Abstract

A 26-year-old man from Afghanistan, with background history of hepatitis B diagnosed 3 years previously, was referred by asylum seeker health centre practitioner with abnormal chest X-ray. He had lived in Pakistan for 1 month prior to moving to Ireland. He had lived in Ireland for one year prior to presenting with persistent dry cough for 4 weeks. He had three cousins with TB whom were fully treated in Afghanistan. He denied usage of intravenous drugs. He was an occasional smoker. He was attending hepatology clinic regularly and was on Tenofovir. On assessment, his vitals and physical examination were unremarkable. However, it was noted that he had right foot ulceration ongoing for a year (Figure 1a). Routine haematology showed lymphopaenia of 0.8 (1–2 × 1016 ml), hyponatraemia of 132 (135-144 mmol/l) and creatine reactive protein of 65 (<5 mmol/l). His chest X-ray (CXR) demonstrated left-sided airspace opacification in the apex.