Title: Tuberculous Dactilitis in Young Male, a Rare Case

Background Tuberculous (TB) infection of metacarpals, metatarsals, and phalanges of hands and feet known as Tuberculous Dactylitis (TD), is a relatively rare presentation of TB, constituting around 10%–15% of all cases of extrapulmonary TB. Most of the patients are younger than 6 years of age. Since tuberculous dactylitis mimics conditions like osteomyelitis and malignancy, early diagnosis and treatment are essential.

Case presentation A 17-years-old male patient with a history of trauma on his hand, had swelling on his right index finger for the last 5 months. He felt numb and no other complaints. Patient was given oral antibiotics and anti-inflammatory medication from primary health care, but there was no improvement. Patient then referred to Orthopedics Department. Radiograph showed a lytic lesion from middle until proximal area of the first phalanx, along with blurred limits of the bone surfaces involved. Chest radiograph showed within normal limit. A magnetic resonance imaging was ordered and suggested primary bone malignancy involving tendon and soft tissue of right index finger. Surgical debridement with open biopsy was done. Pathology results showed caseating granulomas, suggesting the diagnosis of TD. Patient then referred to Pulmonology Department. Tissue culture and Molecular Rapid Test was done for confirmation, but the result was negative. He was then treated with 6-month course of anti-tuberculous drug. After completing the therapy, he came to our department for a follow-up with significant improvement on his hand.

Conclusion Tuberculous Dactylitis of the hand is a very rare entity of the spectrum of extrapulmonary M. tuberculosis infection, especially in adolescent. Clinicians should be more aware concerning this pathology and not to delay the diagnosis, which could lead to permanent deformity. Early diagnosis and treatment can significantly improve outcomes.

Keyword: Tuberculous Dactylitis, Adolescent, Tuberculous Infection, Bone Malignancy

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