Outcome of Neglected Versus Treated Tuberculous Dactylitis in the Same Patient - A case report

Skeletal tuberculosis is a rare form of extrapulmonary Mycobacterium tuberculosis infection. When tubular bones are affected, it is called tuberculous dactylitis (TD). This rare entity can be seen in the hand or foot and has been mentioned in a handful of case reports.

A 56-year-old female patient presented to our clinic for left hand middle finger swelling and pain of 1-year duration. Her medical history was relevant for 15 years history of progressive 4th and 5th fingers malformations that were attributed to "sarcoidosis," and for which she was treated with anti-inflammatory and low dose steroids therapy. At our clinic, physical examination was consistent with a swelling of the base of the middle finger associated with tenderness and decreased range of motion. Radiographs of the hand showed a lytic lesion involving the distal half of the first phalanx, along with blurred limits of the bone surfaces involved. An magnetic resonance imaging was ordered and showed hyper-intense signal of the first phalanx, along with subcutaneous enclosed collections on both sides of the phalanx. Surgical debridement with open biopsy and culture was done. Pathology results showed caseating granulomas, and cultures confirmed the diagnosis of TD. A computed tomography scan of the chest was done postoperatively; where few calcified nodules were noted. She also received a 9-months course of anti-tuberculous drugs and had complete cure by 9 months postoperatively.

TD of the hand is a very rare entity of the spectrum of extrapulmonary M. tuberculosis infection. Clinicians should have a high index of suspicion concerning this pathology not to delay the diagnosis, which could lead to permanent deformity. Early diagnosis and treatment can significantly improve outcomes.