Late Discovering Spina Ventosa: A Case Report

Abstract

Introduction: Spina Ventosa is a rare condition that is easy to misdiagnose as other diseases. We present a case of late-diagnosed Spina Ventosa, which had not only the osteoarticular tuberculosis symptoms but also some severe symptoms, including pleural effusion, ascites, and anemia. By intensive treatment, our patient recovered completely. Case Report: A 7-year-old boy was admitted with complaints of painless swelling of metacarpals, metatarsals, and phalanges of his hands and feet and a discharging sinus of the left toe. There was no family or past history of tuberculosis. His immunizations were up to date. General examination revealed that the child had pallor and was emaciated. No lymphadenopathy was detected. Investigations revealed hemoglobin: 74 g/l, and erythrocyte sedimentation rate (ESR) was 42 mm/hour. QuantiFERON-TB test was positive. The radiograph showed irregular swelling with sclerosis of the underlying bones. The right-hand x-ray showed cortical destruction, sclerosis, and cystic expansion or right second metacarpal. Chest x-ray indicated pleural effusion. Histopathological examination of specimen from the foot and lung and abdomen fluid confirmed tuberculosis. The child was treated with the first-line tuberculosis treatment regimen (Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide) for two months, followed by Isoniazid, Rifampicin, and Pyrazinamide for a further four months. His lesions disappeared after six weeks of intensive treatment. Conclusion:A delay in diagnosis and treatment of tuberculosis can lead to systemic manifestations in multiple organs. Despite the delay in diagnosis, this child had a good outcome due to being treated promptly and adequately after the presentation.

Spina Ventosa of the Left Second Metacarpal in an Adult Indian Male With No Pulmonary Involvement: A First-of-Its-Type Case

“…To the best of my knowledge and after a thorough medical literature search, this is the first case ever reported of a young adult who presents with isolated second metacarpal tuberculosis without any other findings. Nguyen Ngoc et al reported the disseminated tuberculous involvement of the second metacarpal in a child; however, their case differs in that he also had pleural effusion and concomitant infection of the metatarsals and phalanges [12]. There was no involvement from any other site in the present case, and this was an adult.…”

Two rare cases of management of proximal phalanx spina ventosa

“…2 There is frequent involvement of long bones with diffuse sclerosis of short tubular bones of hand and feet. 3 The diagnosis is often delayed owing to its insidious onset and gradual progress due to paucibacillary nature of organism. It can be often be confused with tumours which thus necessitate histopathological testing.…”

“…In children, it usually occurs after an initial untreated tubercular pulmonary infection and are located in peripheral bone, in contrast to adults. 2,3 Initial plain radiographs are usually suggestive of simple cortical demineralization and osteoporosis with absence of periosteal reaction. 2 The lack of awareness among poor socio-economic strata with inadequate rapid diagnostic techniques and occasional inconclusive microbiological and histopathological reports delays the diagnosis even further.…”