Tuberculous Dactylitis : Case Presentation and Functional outcome

Skeletal tuberculosis involving the small bones is less common than pulmonary tuberculosis. Tuberculous dactylitis involves the short tubular bones of the hands and feet more commonly in children. The bones of the hands are the one's more frequently affected than bones of the feet, with the proximal phalanx of the index and middle fingers as the commonest sites for infection. Spread to the skeletal system occurs during the initial infection via the lympho-haematogenous route. The radiographic features of cystic expansion have led to the name "Spina Ventosa" for tuberculous dactylitis of the short bones. We report a case of tuberculous dactylitis in the right little finger.

We describe a 36-year-old woman, who presented with a 12-month history of painless swelling of her right little finger associated with fever and night sweats. Her history was remarkable for persistent productive cough. On examination, her investigation reports and radiographs correlated with the symptoms of tuberculosis, suggestive of tuberculous arthritis. Magnetic resonance imaging of the hand was suggestive of osteomyelitis. Histopathological examination revealed chronic granulomatous inflammation that was consistent with osteomyelitis of the bone due to tuberculosis. However, acid-fast bacilli were not identified. Full course of anti-tuberculosis regimen was commenced. Monthly follow-up and radiographic examinations revealed improvement of the patient under this treatment. She also achieved a good functional outcome.

Tuberculosis should be considered in patients with unusual soft tissue or skeletal lesions in order to make an early diagnosis and to achieve a good functional outcome. Although tuberculosis of the hand has a varied presentation, the majority of lesions respond to conservative treatment, as anti-tuberculosis chemotherapy is the cornerstone in the management of skeletal tuberculosis.