Images in Nephrology (Section Editor: G. H. Neild)

A 64-year-old woman with end-stage renal disease sec-ondary to hypertension undergoing haemodialysis for 2 years was admitted with a history of fever, pain and swollen left foot lasting for 1 year. Clinical exami-nation demonstrated localized erythema, warmness and swelling (Figure 1). The erythrocyte sedimentation rate was 122 mm/h and C-reactive protein was 12.6 mg/dL (normal <0.5 mg/dL). The tuberculin skin test revealed 26 mm enduration with bullous oedema. Thoracic com-puted tomography indicated only calcified lymph nodes in the left hilar region. Magnetic resonance imaging showed destruction in the navicular bone and widespread oedema in the adjacent bones and fluid collection (Figure 2). Af-ter surgical intervention, a diagnosis of tuberculosis (TB) was established with the histopathological examination o