Tuberculous Dactylitis An Uncommon Presentation of Skeletal Tuberculosis

Abstract

BACKGROUND: Skeletal involvement accounts 1-5% of all cases of Tuberculosis. The vertebrae aremore commonly affected. The bones of the hands are more affected than the bones of the feet. The term“spina ventosa” has been used to describe this disorder because of its radiographic features of cysticexpansion of the involved short tubular bones. Tuberculous dactylitis mainly occurs through lympho-hematogenous spread. The lung is the primary focus in 75% of cases.CASE DETAILS: A 4 years old female child developed a painless swelling on her left index finger twomonths prior to her presentation. Following an unsuccessful treatment as a case of osteomyelitis withantibiotics, imaging showed an expansile lytic lesion with sclerosis, and fine needle aspiration confirmedtuberculous dactylitis. The child was initiated on anti-tubercular treatment with subsequent markedclinical and radiologic improvement.CONCLUSION: Presence of longstanding finger swelling and pain should alert a clinician to consideractive disseminated tuberculosis. Furthermore, proper interpretation of imaging and use of fine needleaspiration has been highlighted.