Recurrent tarsal-metatarsal bone tuberculosis presenting with osteomyelitis: a case report

Background: Tuberculosis (TB) remains a major global health concern, with extrapulmonary tuberculosis accounting for a significant portion of cases. Osteoarticular TB, particularly involving the tarsal and metatarsal bones of the foot, is rare and often leads to delayed diagnosis and increased morbidity due to its insidious presentation. The management of such cases is complex, requiring prolonged anti-tubercular therapy (ATT) and sometimes surgical intervention. Treatment adherence is critical for successful outcomes; however, non-adherence remains a major challenge contributing to disease relapse and the emergence of drug resistance. Clinical pharmacists, as integral members of the healthcare team, play a pivotal role in optimizing treatment outcomes through patient education, medication management, monitoring adverse drug reactions, and promoting adherence. Case Presentation: We report a case of a 24-year-old female presenting with pain and swelling in the left foot, initially diagnosed with tarsal-metatarsal bone TB and secondary osteomyelitis. After undergoing surgical debridement and commencing standard ATT, the patient discontinued therapy prematurely. She returned with recurrent symptoms including pain, swelling, low-grade fever, and a discharging sinus. Investigations confirmed active infection with rifampicin-sensitive Mycobacterium tuberculosis. ATT was restarted alongside wound management and adherence counseling. Discussion: This case highlights the complexities of managing extrapulmonary TB and underscores the critical role of clinical pharmacists in improving patient adherence and preventing treatment failure. Through targeted pharmaceutical care interventions and collaboration within multidisciplinary teams, clinical pharmacists help mitigate complications, support prolonged therapy requirements, and improve clinical outcomes. Conclusion: Clinical pharmacist involvement is essential in the comprehensive management of osteoarticular TB to enhance adherence, monitor therapy, and ultimately reduce relapse rates and drug resistance. This case exemplifies the need for integrated care models in managing complex TB cases.