Clinical Pain

Korean Association of Pain Medicine (대한임상통증학회)
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Calcaneal Osteomyelitis Presenting as a Paradoxical Reaction during Treatment of Multidrug-Resistant Tuberculosis

다제내성 결핵의 치료 중 역설적 반응으로 나타난 종골 골수염

  • Han, Yong Hyun (Department of Rehabilitation Medicine, Dong-Eui Medical Center) ;
  • Lee, Chang Hwa (Department of Rehabilitation Medicine, Masan National Tuberculosis Hospital) ;
  • Bae, Min Joon (Department of Rehabilitation Medicine, Dong-Eui Medical Center) ;
  • Hwang, Kihun (Department of Rehabilitation Medicine, Dong-Eui Medical Center)
  • 한용현 (부산동의병원 재활의학과) ;
  • 이창화 (국립마산병원 재활의학과) ;
  • 배민준 (부산동의병원 재활의학과) ;
  • 황기훈 (부산동의병원 재활의학과)
  • Received : 2019.02.07
  • Accepted : 2019.05.31
  • Published : 2019.12.31
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Abstract

Tuberculosis in the foot progresses gradually; thus, diagnosis is usually delayed, and early treatment is rarely provided. If osteomyelitis occurs due to delayed diagnosis and treatment, surgical treatment should be considered. We report the case of a 46-year-old man with osteomyelitis of the calcaneus who was diagnosed with multidrug-resistant pulmonary tuberculosis and he was treated with anti-tuberculosis drugs. Bilateral adrenal masses, abscess of both testes and a small wound in the left plantar heel were observed. Both adrenal masses and abscess were regarded as paradoxical reaction of anti-tuberculosis treatment. After 1 month, he developed a pain in the left plantar heel that was compatible with calcaneal osteomyelitis in radiological features. He underwent right orchiectomy for right scrotal abscess aggravation and surgical treatment for left calcaneal osteomyelitis. Mycobacterium tuberculosis was confirmed by polymerase chain reaction. The patient was immobilized by cast for 8 weeks and the heel pain gradually improved.

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