[Rapidly growing tumor of the hand--is tuberculosis as differential diagnosis gaining increased importance?]

A two-year-old healthy, Portuguese girl presented with a prominent, painless tumor over the first web space of the left hand. The tumor increased rapidly in size over a few weeks, but caused no functional problems. On X-ray films, a cystic structure of the first metacarpal bone with erosion of the corticalis was demonstrated. At operation, a "cold abscess" was found. Bacterial examination of the gastric juice showed acid-resistant bacilli. The spina ventosa (Latin: Spina-"a thorn"; ventosa-"full of wind, distended") is a typical extrapulmonary manifestation of tuberculosis in phalangeal, metacarpal, and metatarsal bones of children. The recognition of this diagnosis is very important and will become more so in the future as it has already been seen in HIV-positive children in the USA, as well as in immuno-suppressed children and in un-vaccinated and malnourished children from war zones in eastern Europe.