Tuberculous dactylitis presenting as paronychia with pseudopterygium and nail dystrophy

Scrofuloderma is a type of secondary tuberculosis (TB) arising from contiguous involvement of skin by an underlying tuberculous focus in the lymph nodes or bones. It may occasionally be the presenting feature of osteoarticular TB. Tuberculous dactylitis is the involvement of the small tubular bones of the hands and feet, and most cases occur in children younger than 6 years of age. Fingers are more commonly involved than toes, and painless swelling of a digit is the usual presentation. Involvement of the toes is rare, with only a few reported cases. The indolent clinical course leads to a delay in diagnosis, and bone shortening with joint deformity is the usual outcome, especially in tuberculous dactylitis affecting the foot. We report here a case of tuberculous dactylitis of the great toe and scrofuloderma affecting the nail fold presenting as painless paronychia with pseudopterygium and nail dystrophy. Nail involvement led to an early presentation and timely diagnosis and treatment before progression to permanent bone or joint deformity.