ABSTRACT
Osteomyelitis of the finger presents a challenging problem. Although there are multiple treatments described in the literature, the infection often results in eventual amputation. The authors present a case of an open fracture of the index finger complicated by nonunion, infection, and osteomyelitis. This was successfully treated by the placement of an antibiotic cement spacer and subsequent reconstruction with iliac crest bone graft, after the 2-stage Masquelet technique, using intravenous and oral antibiotics. They show that this technique, although infrequently described in the hand and fingers, can be a successful option for the treatment of phalangeal osteomyelitis and phalangeal reconstruction.
Subject(s)
Finger Phalanges/surgery , Fracture Fixation/methods , Fractures, Ununited/surgery , Osteomyelitis/therapy , Anti-Bacterial Agents/administration & dosage , Bone Cements , Debridement , Diabetes Mellitus, Type 2/complications , Finger Phalanges/injuries , Finger Phalanges/microbiology , Fractures, Open/surgery , Fractures, Ununited/etiology , Humans , Ilium/transplantation , Male , Middle Aged , Osteomyelitis/microbiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus haemolyticusSubject(s)
Antitubercular Agents/therapeutic use , Finger Phalanges/diagnostic imaging , Mycobacterium tuberculosis/isolation & purification , Synovial Fluid/microbiology , Tuberculosis, Osteoarticular/microbiology , Diagnosis, Differential , Finger Phalanges/microbiology , Humans , Male , Middle Aged , Radiography , Synovial Fluid/diagnostic imaging , Tuberculosis, Osteoarticular/diagnosis , Tuberculosis, Osteoarticular/drug therapy , Ultrasonography , Ultrasonography, DopplerSubject(s)
Arthritis, Infectious/etiology , Gram-Positive Bacterial Infections/microbiology , Lactobacillus plantarum/isolation & purification , Osteoarthritis/etiology , Thumb , Wound Infection/microbiology , Amoxicillin/therapeutic use , Amputation, Surgical , Arthritis, Infectious/drug therapy , Arthritis, Infectious/microbiology , Arthritis, Infectious/surgery , Citrus sinensis/microbiology , Combined Modality Therapy , Diabetes Complications/microbiology , Disease Susceptibility , Drug Resistance , Drug Substitution , Finger Phalanges/diagnostic imaging , Finger Phalanges/microbiology , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/etiology , Gram-Positive Bacterial Infections/surgery , Humans , Lacerations , Lactobacillus plantarum/drug effects , Lactobacillus plantarum/pathogenicity , Male , Middle Aged , Osteoarthritis/drug therapy , Osteoarthritis/microbiology , Osteoarthritis/surgery , Thumb/injuries , Thumb/microbiology , Thumb/surgery , Vancomycin/pharmacology , Vancomycin/therapeutic useABSTRACT
Tuberculosis dactylis is exceptional. We report tuberculous dactylitis in three women who were 51, 44, and 62-year-old, respectively. The diagnosis was suspected on chronic and insidious clinical presentation, and confirmed by histology. Disease course was favourable with antibuberculosis regimen but two patients had permanent hand disability. Clinical and therapeutic issues are discussed in the context of an endemic country.
Subject(s)
Antitubercular Agents/therapeutic use , Diabetes Mellitus, Type 2/complications , Finger Phalanges/diagnostic imaging , Immunocompromised Host , Tuberculosis, Osteoarticular/diagnosis , Tuberculosis, Osteoarticular/drug therapy , Adult , Biopsy , Female , Finger Phalanges/microbiology , Finger Phalanges/pathology , Humans , Middle Aged , Radiography , Risk Factors , Time Factors , Treatment Outcome , Tuberculin Test , Tuberculosis, Osteoarticular/complicationsABSTRACT
The prevalence of tuberculosis (TB) continues to rise worldwide. Current migration patterns and increased travel to high-prevalence TB countries will result in more frequent presentations of less common forms of TB. Tuberculous dactylitis, a form of tuberculous osteomyelitis, is well recognised in countries with a high prevalence of TB. We provide a systematic review of all published cases of tuberculous dactylitis in children and adolescents and describe a case to illustrate the typical features of the disease. Our review revealed 37 cases of tuberculous dactylitis in children and adolescents, all reported in the last 17 years. Children less than 10 years of age are most frequently affected and the hand is the most commonly affected site. Concurrent pulmonary TB is present in a fifth of cases and systemic symptoms are usually absent. Positive TST and IGRA support the presumptive diagnosis, but cannot be used as rule-out tests. The definitive diagnosis relies on the detection M. tuberculosis by PCR or culture. Treatment should comprise of a standard three to four drug anti-tuberculous regimen. The optimal treatment duration remains unknown. Surgery has a limited role in the treatment in general but may play a supportive role, and curettage of the cavity has been recommended for avascular lesions.
Subject(s)
Antitubercular Agents/administration & dosage , Finger Phalanges , Fingers , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Osteoarticular/diagnosis , Adolescent , Child , Drug Therapy, Combination , Female , Finger Phalanges/diagnostic imaging , Finger Phalanges/microbiology , Finger Phalanges/pathology , Fingers/diagnostic imaging , Fingers/pathology , Humans , Male , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/genetics , Radiography , Tuberculosis, Osteoarticular/epidemiology , Tuberculosis, Osteoarticular/microbiology , Tuberculosis, Osteoarticular/therapyABSTRACT
Tuberculosis is a common illness in developing nations. Tuberculous dactylitis is an unusual manifestation of tuberculous osteomyelitis seen predominantly in children. A woman presented with painless, fusiform swelling of multiple digits of the hand. Synovial biopsy revealed granulomatous inflammation and the pus smear was positive for acid-fast bacilli. She underwent debridement of the involved digits and was initiated on antituberculous therapy. This is an unusual presentation of tuberculous dactylitis in an immunocompetent host which involved multiple digits in a single hand.
Subject(s)
Mycobacterium tuberculosis , Tuberculosis, Osteoarticular/diagnostic imaging , Tuberculosis, Osteoarticular/microbiology , Adult , Female , Finger Phalanges/diagnostic imaging , Finger Phalanges/microbiology , Finger Phalanges/pathology , Hand/diagnostic imaging , Hand/pathology , Humans , Mycobacterium tuberculosis/pathogenicity , Radiography , Tuberculosis, Osteoarticular/pathologyABSTRACT
BACKGROUND: Although a few studies have shown fine needle aspiration cytology (FNAC) to be a sensitive diagnostic tool in the detection of nerve involvement, its role as an initial diagnostic procedure in pure neuritic leprosy (PNL) and in the detection of skeletal lesions with unusual findings has not been documented before. CASES: Three patients who presented with thickened nerves and a fourth with biopsy-proven lepromatous leprosy with lesions in hand bones underwent FNAC. Of the 3 patients with nerve thickening, 2 had a clinical suspicion or diagnosis of neuritic leprosy, whereas in the third patient a clinical differential diagnosis of a soft tissue tumor or parasitic cyst was considered. FNAC in all 3 cases revealed epithelioid cell granulomas, Langhans giant cells and caseous necrosis. Fites and Ziehl-Neelsen stains were negative for acid-fast bacilli. Cytologic diagnosis of pure neuritic leprosy was made in all 3 cases and confirmed by histopathologic examination. FNAC of skeletal lesions from the fourth patient confirmed involvement of bone with unusual cytologic findings of epithelioid cell granulomas and giant cells along with a significant proportion of foamy macrophages and strong Fites stain positivity. CONCLUSION: FNAC is a simple, useful, minimally traumatic and routinely applicable procedure in the diagnosis of pure neuritic leprosy and leprous osteitis.