Case Report: “Spina Ventosa” Tuberculous Dactylitis in a 2 Year Old Boy - A Very Rare Disease

Department of Orthopaedics, Bankura Sammilani Medical College, Gobindanagar, P.O. Kenduadihi, Bankura, Pin - 722102, India.
The Open Orthopaedics Journal 03/2012; 6:118-20. DOI: 10.2174/1874325001206010118
Source: PubMed


Tuberculous infection of metacarpals, metatarsals and phalanges is known as tuberculous dactylitis. There is a spindle shaped expansion of the short tubular bones due to tuberculous granuloma. Hence it is also known as spina ventosa. In our case, a two year old boy with a swelling in the metacarpal was provisionally diagnosed as enchondromata while the possibility of spina ventosa was kept in mind. He was posted for excision of the metacarpal followed by bone grafting. Histopathological examination report confirmed it as spina ventosa.

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    ABSTRACT: Tuberculous dactylitis is a distinctly uncommon, yet well recognized form of tuberculosis involving the small bones of the hand or foot. It occurs in young children in endemic areas under 5 years of age. Tuberculosis of the short tubular bones like phalanges, metacarpals or metatarsals is quite uncommon beyond 6 years of age, once the epiphyseal centers are well established. The radiographic features of cystic expansion have led to the name "Spina Ventosa" for tuberculous dactylitis of the short bones. Scrofuloderma is a mycobacterial infection affecting children and young adults, representing direct extension of tuberculosis into the skin from underlying structures e.g. lymph nodes. An 8-year-old malnourished girl had multiple axillary ulcers with lymphadenopathy. Tuberculous dactylitis with ipsilateral axillary scrofuloderma was suspected on clinical and radiological grounds. The suspicion was confirmed by histology and bacteriology. The patient responded to antitubercular drugs with progressive healing of the lesions without surgery. Concomitant presence of these dual lesions suggesting active disseminated tuberculosis in immune-competent child over 6 years is very rare and hardly reported.
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    ABSTRACT: The literature and statistics on tuberculous dactilitis (TD) are scarce and most literature consists of isolated case reports. The aim of this case series is to examine trends and diagnostic difficulties faced by the clinicians in diagnosing this rare disorder. Google search engine and MEDLINE were searched for key words ‘tuberculous dactylitis’ and ‘spina ventosa’. From all published papers and unpublished reports, 58 cases were extracted and 61 cases, including the three presented by us in this review, were analyzed for a set of 16 parameters. There is re-emergence and increase in the incidence of this form of extra-pulmonary tuberculosis (EPTB) especially in the industrialized countries, which poses a diagnostic challenge to physicians in these countries, as they are not well versed with this entity. - See more at:
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