Tubercular Dactylitis: Cytodiagnosis to Rescue- A Report of Two Cases - Abstract
Introduction: Skeletal tuberculosis of the small tubular bones of hand and feet is less frequently encountered. It accounts for less than 1% of extra pulmonary tuberculosis with spine being the most frequent site of involvement. Small bones of hand area involved with greater frequency than the foot and condition is relatively rarer after the age of 5 years. Fine needle aspiration cytology is an inexpensive relatively non-invasive procedure that aids in early diagnosis of tubercular dactylitis.
Case reports:
Case 1: A 47 year old female presented with swelling of the left great toe for the past three months. There was a history of trauma few weeks prior to onset of swelling. On radiography there was a bony lytic lesion in the proximal phalanx of left great toe. Chest x-ray showed no abnormality. Fine needle aspiration cytology from swelling revealed granulomas. Ziehl Neelsen staining was positive for acid fast bacilli. Patient was given anti tubercular drugs for 9 months following which the swelling subsided.
Case 2: A 19 year old female patient presented with a history of painful swelling of 2 months duration in the right middle finger. Family history was not contributory. Radiographs showed an expansile lesion of right third middle phalanx. Chest X-ray was normal. Tuberculin test was strongly positive. Fine needle aspiration showed epitheloid cell clusters with multinucleated giant cells and acid fast bacilli was positive on Ziehl Neelsen staining. The patient was commenced on anti-tubercular treatment.
Conclusion: To ensure early and good functional outcome, tuberculosis should be considered in patients with soft tissue or bony lesions of small bones of hand and feet. FNAC can serve as an inexpensive and relatively less invasive procedure which helps attain diagnosis. Institution of conservative anti-tubercular treatment is cornerstone in the management of such patients.