TB dactylitis in a toddler

A well-thriving male toddler presented with a painless swelling on the dorsal surface of his right hand, incidentally noticed by the mother. There was no history of local trauma or any systemic symptoms. On examination, there were no signs of inflammation over the swelling. An X-ray was taken, and an expansile lytic lesion of the right fifth metacarpal bone was seen. He underwent debridement, and the tissue was sent for histopathological examination (HPE) and cartridge-based nucleic acid amplification test (CBNAAT) for Mycobacterium tuberculosis (M. tb). HPE revealed ill-defined granulomas and multinucleated giant cells, and CBNAAT was positive for M. tb-rifampicin sensitive. The child was started on antitubercular therapy. He is doing well on follow-up. Awareness of this presentation of tuberculous dactylitis and its timely diagnosis will help in minimising complications and facilitate complete resolution of the infection.