PMC5089153_01
Imaging of chest (a) x-ray and (b) CT scan during initial hospitalization depicting miliary TB pattern.
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Admission chest x-ray was suggestive of miliary TB (Fig. 1a). CT demonstrated a diffuse pattern of nodules throughout both lungs, also suggestive of military TB (Fig. 1b).
Imaging of the right foot (a) x-ray and (b) MRI from initial hospitalization depicting the destruction of the navicular cuneiform bones as well as the joints.
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Radiography and magnetic resonance imaging (MRI) of the right foot and ankle revealed significant destruction of the navicular cuneiform joints with associated osteomyelitis compared to initial imaging 1 year prior (Fig. 2a and b).
Acid-fast bacilli (beaded red stained mycobacterial rods, as marked with arrow) with inflammatory debris from right ankle fine needle aspiration (Ziehl Neelsen 1500x).
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A fluoroscopy guided bone biopsy of the right first cuneiform was performed which revealed severe acute and chronic mycobacterial osteomyelitis with numerous AFB (Fig. 3).
Imaging of chest comparing (a) pre-treatment, (b) 3 months post-treatment, and (c) 1 year post-treatment. Note the improvement of miliary TB pattern with treatment.
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Follow-up with 3 months of anti-TB treatment, repeat chest x-ray showed significant improvement from the previously seen miliary TB pattern (Fig. 4).
Imaging of right foot comparing (a) prior treatment and (b) 1 year post-treatment. Note the marked improvement of the navicular and cuneiform bones.
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Follow-up chest x-ray and MRI of his right foot showed no pulmonary abnormalities and significant improvement of the navicular and first and second cuneiforms of the right foot, with the bones appearing relatively normal (Fig. 5).