Tuberculous dactylitis—an easily missed diagnosis

Abstract

The prevalence of tuberculosis (TB) continues to rise worldwide. Current migration patterns and increased travel to high-prevalence TB countries will result in more frequent presentations of less common forms of TB. Tuberculous dactylitis, a form of tuberculous osteomyelitis, is well recognised in countries with a high prevalence of TB. We provide a systematic review of all published cases of tuberculous dactylitis in children and adolescents and describe a case to illustrate the typical features of the disease. Our review revealed 37 cases of tuberculous dactylitis in children and adolescents, all reported in the last 17 years. Children less than 10 years of age are most frequently affected and the hand is the most commonly affected site. Concurrent pulmonary TB is present in a fifth of cases and systemic symptoms are usually absent. Positive TST and IGRA support the presumptive diagnosis, but cannot be used as rule-out tests. The definitive diagnosis relies on the detection M. tuberculosis by PCR or culture. Treatment should comprise of a standard three to four drug anti-tuberculous regimen. The optimal treatment duration remains unknown. Surgery has a limited role in the treatment in general but may play a supportive role, and curettage of the cavity has been recommended for avascular lesions.

Troublesome Tuberculosis: A Case Report on Multi-focal Tuberculous Osteomyelitis in An Immunocompetent Patient

“…The National Health Service now provides a wider TB care pathway to the public and aims to provide more effective health care to hard-to-reach groups such as prisoners, drug users and the homeless population [6]. Interferon gamma enzyme linked immunosorbent assay (Quantiferon test) and tuberculin skin test (TST) have been used in the detection of latent tuberculosis [3,7,8]. These are particularly useful in identifying tuberculosis among high risk populations such as migrants from high endemic areas.…”

“…It is frequently associated with disseminated disease [3]. Typical sinus formation of dactylitic bone may not always be present.…”

Osteoarticular tuberculosis dactylitis: Four cases

“…The rarity of the isolated osseous involvement 187 of the phalanxes of the fingers would be due to the small size 188 of the bones of the hand. The majority of the cases of digital by a radio clinical discordance because of the long tolerance 192 of the disease [11]. The patient usually presents with a long-193 time progressive isolated tumefaction that causes little pain 194 or completely painless, and is able to evolve to fistulization 195 [8].…”

Tuberculous dactylitis (spina ventosa) with concomitant ipsilateral axillary scrofuloderma in an immunocompetent child: A rare presentation of skeletal tuberculosis

“…The definitive diagnosis relies on the detection M. tuberculosis by PCR or culture. [15] Tuberculin test may provide useful supportive evidence in difficult cases. [1] The optimal treatment duration for tubercular dactylitis remains unknown.…”