Unusual presentation of late reactivated tuberculosis in immunosenescence after nine decades latency

INTRODUCTION  Tuberculosis is an often underestimated infectious disease which can lead to manifest infections even after years of latency. Pulmonary manifestations are by far the most frequent, although any other organ can be equally affected. HISTORY  A 95-year old patient presented with a localized painful swelling of the right foot for further investigation. Despite her advanced age there were no pre-existing medical conditions, except for a club foot existing since early childhood. FINDINGS AND DIAGNOSIS  On physical examination we found a hyperemic fluctuant swelling of 5 cm diameter at the arch of the right foot. The X-ray showed a complete destruction of the regular osseous structures from the upper ankle joint to the proximal metatarsal bones. THERAPY AND COURSE  Intraoperatively the suspicion of an abscess was confirmed and material was obtained for microbiological investigation. Liquid cultures grew Mycobacterium tuberculosis. In an MRI-scan, involvement of the tarsal and metatarsal bones could not be excluded, thus the duration of the standard antituberculose treatment was set to 9 months. CONCLUSIONS  Tuberculosis, primary or reactivated, should always be considered as a potential cause of unclear infections; especially in patients with anticipated immunosenescence.