Osteoarticular tuberculosis of the hand

Corresponding author: Miriam Paz Contact Information: Miriampazsierra@hotmail.com DOI: 10.12746/swrccc.v10i44.1069 A 35-year-old man who emigrated from Cameroon in 2008 with no past medical history presented to a local clinic complaining of a painless left finger mass which had been present for 5 years. The patient came to the outpatient clinic because the skin over his finger started to breakdown, especially with flexion, but there was no drainage. The patient’s vital signs were normal, and he was afebrile. On physical examination, he had severe swelling of the entire left third finger, worse over the dorsal aspect of the finger at the proximal interphalangeal joint (PIP) (Figure 1). There was a scaly plaque on the dorsal PIP but no warmth, erythema, or drainage. A CBC, rheumatoid factor, anticitrulline antibodies, HIV test, electrolytes, and ANA were normal or negative. A magnetic resonance image of the hand (Figure 2) showed an enhancing third finger mass seen around the third finger proximal and middle phalanges and the third finger flexor and extensor tendons, causing enlargement of the digit. This mass extended more proximally around the flexor tendons. A biopsy with cultures and stains for fungi, anaerobic and aerobic bacteria and mycobacteria grew Mycobacterium tuberculosis. The acid-fast bacillus stain was negative. His chest x-ray was clear without infiltrates, masses, or nodules. The patient started on antituberculous treatment through the Department of State Health Services.