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(1):118-20. DOI: 10.2174/1874325001206010118
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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- "Differential diagnosis worth considering in such cases includes pyogenic osteomyelitis, Brodie's abscess, Atypical mycobacterial infection (due to mycobacterium scrofulaceum and M. avium-intracellulare), Actinomycosis or other deep mycosis (Sporotrichosis, Botryomycosis, Nocardiosis etc), Kaposi's sarcoma and luetic dactylitis. There is recent published report of diagnostic dilemma and radical excision of such lesion as tumor in a young 2-year-old child. Presence of draining sinus in the tuberculous osteomyelitis may hinder its distinction from pyogenic disease. "
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.
Article: Dactilitis[Show abstract] [Hide abstract]
ABSTRACT: In the medical literature dactylitis is defined as a “inflammation of a finger or toe”. It is a typical manifestation of spondyloarthritides, especially of psoriatic arthritis, although this peculiar inflammation can be produced by other entities, such as inflammatory dactylitis (spondyloarthritis, gout or sarcoidosis), infectious dactylitis (tuberculosis, syphilis or blistering distal dactylitis) or non-inflammatory dactylitis (sickle-cell disease). In spondyloarthritis, dactylitis is the result of a flexor tenosynovitis and secondarily of small joint synovitis. Some clinical trials with tumor necrosis factor (TNF)-blockers have evaluated secondary dactylitis and have generally shown efficiency in the control of this peculiar sign. Gout can produce dactylitis due to urate crystal deposits, while other radiological features are similar to those of spondyloarthritides. Chronic sarcoidosis is another cause of dactylitis secondary to granulomatous invasion of the bone and soft tissues. Infectious forms of dactylitis are typical in pediatric ages and can be due to osteomyelitis, as in the case of tuberculosis and syphilis, or to infection of the soft tissues, as in blistering distal dactylitis. Finally, in sickle cell anemia, inflammation is a result of bone marrow infarction.
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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: http://www.jpmsonline.com/jpms-vol4-issue4-pages184-190-cr.html#sthash.nna7DLmd.dpuf