Distal tibial tuberculous osteitis in a child: a case report.

We present a case of a 2-year-old child with persistent synovitis of the right ankle joint accompanied by a subfebrile temperature. The child had received Bacillus Calmette-Guérin vaccination and had minimal laboratory abnormalities. Thorough imaging studies revealed a well-defined osteolytic lesion of the distal tibial metaphysis with partial physeal and epiphyseal involvement. Targeted biopsy with polymerase chain reaction and histopathological examination demonstrated caseating granulomatous inflammation with Langhans-type giant cells and confirmed Mycobacterium tuberculosis without Rifampicin resistance. Surgical curettage was performed with preservation of the physeal circumference, followed by weight-adjusted four-drug anti-tuberculous therapy for 2 months and prolonged dual therapy, with a total treatment duration of 9 months. At 18-month follow-up, the child was asymptomatic, with full range of motion and preserved longitudinal tibial growth. Early diagnosis, targeted biopsy, appropriate surgical management, and prolonged chemotherapy are critical for optimal outcomes.