Tuberculous dactylitis is an uncommon condition which is particularly difficult to differentiate from other lesions, particularly tumors. We report the case of a 56-year-old, healthy, left-handed person who consulted for progressive painful swelling of 8-month duration in the right thumb, which had developed after direct trauma. The plain radiograph of the thumb revealed extensive destruction of the proximal phalanx associated with pathological fracture. Magnetic resonance imaging (MRI) showed replacement of the affected phalanx with prominent soft tissue mass with extension outside the bone margins. The diagnosis of tuberculous dactylitis was based on histological characteristics and positive acid fast bacilli using Ziehl-Neelsen stain. Surgical debridement and anti-tuberculous chemotherapy eradicated the infection. Seven years post treatment, the patient had good function of the thumb with no significant disability interfering with his daily activity.
Leung PC (1978) Tuberculosis of the hand. The Hand 10(3):285– 291
Jensen CM, Jensen CH, Paerregaard A (1991) A diagnostic problem in tuberculous dactylitis. J Hand Surg Br 16(2):202–203
Subasi M, Bukte Y, Kapukaya A, Gurkan F (2004) Tuberculosis of the metacarpals and phalanges of the hand. Ann Plast Surg 53(5):469–472
Coombs R, Fitzgerald RH (1989) Infection in the orthopaedic patient, 1st edn. Butterworth & Co Ltd, Great Britain, pp 297– 298
Agarwal S, Caplivski D, Bottone EJ (2005) Disseminated tuberculosis presenting with finger swelling in a patient with tuberculous osteomyelitis: a case report. Ann Clin Microbiol Antimicrob 4:18. doi:10.1186/1476-0711-4-18
Andronikou S, Smith B (2002) “Spina ventosa” tuberculous dactylitis. Arch Dis Child 86(3):206
Al-Qattan MM, Bowen V, Manteo RT (1994) Tuberculosis of the hand. J Hand Surg Br 19:234–237
Teo SY, Ong CL (2006) Clinics in diagnostic imaging. Singapore Med J 47(3):243–249
De Vuyst D, Vanhoenacker F, Gielen J, Bernaerts A, De Schepper AM (2003) Imaging features of musculoskeletal tuberculosis. Eur Radiol 13:1809–1819
Yoon CJ, Chung HW, Hong SH, Kim CJ, Kang HS (2001) MR findings of tuberculous dactylitis. Eur J Radiol 39(3):163–167
Wessels G, Hesseling PB, Beyers N (1998) Skeletal tuberculosis: dactylitis and involvement of the skull. Pediatr Radiol 28:234– 236
Albornoz MA, Mezgarzedeh M, Neumann CH, Myers AR (1998) Granulomatous tenosynovitis: a rare musculoskeletal manifestation of tuberculosis. Clin Rheumatol 17:166–169
Sunderamoorthy D, Gupta V, Bleetman A (2001) TB or not TB: an unusual sore finger. Emerg Med J 18(6):490–491
Vanmarsenille JM, de Berg B, Houssiau FA, de Selys J (2003) Unusually prolonged course of tuberculous dactylitis with osteitis. Joint Bone Spine 70:535–537