Disseminated tuberculosis presenting as finger swelling in a 2-year-old: a case report of TB osteomyelitis

Tuberculosis (TB) is a chronic granulomatous infection caused by Mycobacterium tuberculosis. TB primarily affects the lungs. A small percentage of cases are associated with extrapulmonary TB (EPTB). Of all EPTB, skeletal TB accounts for 1-5% of the cases, with the vertebrae being the most commonly affected. Involvement of the hands usually occurs in children under the age of six, with the bones of the proximal phalanx of the middle and index fingers being the most reported sites of infection. We describe a case of disseminated TB presenting as swelling in the index finger. Due to its nonspecific symptoms and insidious course, this condition is frequently overlooked. The presented case is unique compared to other documented TB cases as the child did not undergone Bacillus Calmette-Guérin (BCG) vaccination, a factor that might have contributed to the disease progression. Additionally, traditional cauterization was noted in the patient's history, a practice that could complicate the diagnosis. Physicians should consider TB osteomyelitis when encountering young patients with finger swelling, particularly in endemic areas. Prompt recognition and diagnosis of TB osteomyelitis are crucial for early intervention and better outcomes.