Spina Ventosa: An often Missed Diagnosis

Area of Science:

• Orthopedics
• Infectious Diseases
• Radiology
• Pathology

Background:

• Tuberculosis (TB) presents with diverse clinical manifestations, often complicating diagnosis.
• Bone tuberculosis, particularly spina ventosa, can present insidiously, mimicking other conditions.
• Delayed diagnosis of bone TB can lead to significant morbidity.

Purpose of the Study:

• To highlight the diagnostic challenges of spina ventosa in an adolescent.
• To emphasize the importance of considering rare presentations of tuberculosis.
• To underscore the role of imaging and microbiological studies in confirming the diagnosis.

Main Methods:

• Case presentation of an adolescent female with a 5-month history of hand swelling.
• Clinical examination revealing a soft bulging mass with discharge.
• Diagnostic imaging including plain radiography and magnetic resonance imaging (MRI).
• Laboratory investigations: erythrocyte sedimentation rate (ESR), Gram staining, and auramine staining.
• Surgical intervention: incision and drainage.
• Histopathological confirmation via biopsy.

Main Results:

• Radiography showed periosteal elevation and bony destruction of the proximal phalanx.
• MRI revealed signal intensity changes and a collection consistent with infection.
• Cytology and staining confirmed spina ventosa (tuberculosis of the bone).
• ESR was slightly elevated; other blood investigations were normal.

Conclusions:

• Spina ventosa can present as a chronic swelling, often misdiagnosed as an abscess.
• A high index of suspicion and appropriate diagnostic workup, including biopsy, are essential.
• Antitubercular therapy is the primary treatment for spina ventosa.