Bilateral Tubercular Dactylitis: Unusual presentation of an usual disease

Bilateral tuberculous dactylitis of both hand and feet in a female toddler: a case report on a rare presentation of skeletal tuberculosis in children

BACKGROUND

Even though tuberculosis is a common disease among children in developing countries, tuberculous dactylitis is an uncommon form of Skeletal tuberculosis specially with involvement of both the hands and feet.

CASE PRESENTATION

A one-and-a-half-year-old previously healthy female Ethiopian toddler presented to our pediatric outpatient clinic with a history of two-month duration of painful multiple swellings over both her hands and feet. The swelling involved the proximal phalanx of the left index finger, dorsum of the right hand, and dorsum of both feet over the first metatarsal bone. Physical examination, radiologic findings, and histopathology suggested tuberculous dactylitis. The patient was treated with anti-tuberculosis drugs for one year and she showed clinical and radiologic improvement and recovery.

CONCLUSION

Tubercular dactylitis should be considered in the differential diagnosis of children from endemic areas presenting with bone and joint pain or swelling. Our experience of a twelve-month course of antitubercular treatment, which is in line with WHO recommendations, for skeletal tuberculosis, showed excellent outcomes.

Tuberculous Dactylitis in Adult - A Case Report and Review of Literature

Introduction:

Tubercular dactylitis is an uncommon form of musculoskeletal tuberculosis (TB), especially after the age of 5 years without any risk factors.

Case Report:

A case of 49-year-old male presented with pain, swelling, and discharging sinus of proximal phalanx of third digit of the right hand with no constitutional symptoms for 2 years, with multiple failed treatment in form of antibiotic therapy. There were no risk factors such as immunodeficiency or any co-morbidities. The plain radiograph was suggestive of increased bone density with mild periosteal reaction; magnetic resonance imaging was suggestive of tubercular osteomyelitis. A biopsy was performed, the gene expert of the sample revealed TB with no drug resistance. The patient was managed with anti-tubercular drugs with complete resolution of clinical and radiological symptoms at 1-year follow-up.

Conclusion:

TB should be considered a differential in patients with chronic soft-tissue or skeletal lesions even in the absence of the usual risk factors because with treatment it still carries a good prognosis.