Tubercular Dactylitis in a 5-Year Girl: A Case Report on Uncommon Presentation of Skeletal Tuberculosis

Abstract

Tuberculosis of the spinal cord, which is known as tubercular spondylitis is the most manifested musculoskeletal TB. Tuberculosis also affects the hip joint, knee joint, wrist, and elbow joint in descending order. Tubercular Dactylitis is a less common form of extra-pulmonary tuberculosis, which involves the small bones of the hand and feet. Tuberculosis causes granuloma formation in short tubular bones resulting in spindle shaped swelling, which is Spina Ventosa. A5 years old Bangladeshi girl presented to the orthopaedics department with a history of pain-free gradual expansion of the middle phalanx of the left index finger for 3 consecutive months. Findings of physical and radiographic examination were in line with tubercular dactylitis. Curettage and allogenic bone grafting procedure was performed. Then tubercular dactylitis was ensured by histo-pathological examination. The patient was further treated with Anti-TB drugs for 12 months. Clinical and functional outcomes were satisfactory and there was no recurrence after 2 years of follow-up. As tubercular dactylitis is an infrequent presentation of skeletal tuberculosis, diagnosis, and management decision was difficult. Our experience in treating the patient with curettage and allogenic bone grafting along with 12 months anti-tubercular medications was excellent. So, this can be recommended as one of the best modalities of treatment of tubercular dactylities in children.