Unusual presentation of isolated metacarpal tuberculosis

Abstract

Metacarpal tuberculosis is a rare presentation of the disease; it represents only 1% of all bone sites. The following report documents the case of a 28-year-old female who sought a consultation for a painful right hand following an injury. Radiographs showed a fracture of the distal fifth metacarpal through a lytic lesion. Histology of a biopsy specimen revealed granulomas with caseous necrosis, specific to tuberculosis. The patient experienced a complete recovery with anti-tubercular treatment. This case of an unusual presentation of isolated metacarpal tuberculosis was reported with the intention of highlighting the rarity of this location. It is therefore imperative to bear in mind the possibility of such atypical presentations of tuberculosis when making a rapid and correct diagnosis and prescribing adequate treatment.

Isolated Tuberculosis of Capitate and Triquetrum

“…Chest Xray was negative, as is the case in two-third of the patients with bone tuberculosis. 4 Furthermore Ziehl-Nelson staining and aerobic cultures were negative. In hand tuberculosis, microbiological studies are usually insufficient in the diagnosis of bone and joint tuberculosis.…”

“…Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and mainly affects the respiratory system. 4 However, tuberculosis can also be manifested as an osteoarticular infection. In these cases, it mainly concerns a spondylitis or a monoarthritis of weight-bearing joints such as hip, knee, shoulders, or elbow.…”

“…In these cases, it mainly concerns a spondylitis or a monoarthritis of weight-bearing joints such as hip, knee, shoulders, or elbow. 1,4,5 The wrist is a more unusual site for osteoarticular tuberculosis and accounts for only 1% of all cases of peripheral osteoarticular tuberculosis. 5 Because of the infrequency and atypical features of wrist tuberculosis, diagnosis of this disease is often difficult.…”

“…Because the clinical and radiological features of tuberculous osteomyelitis are nonspecific, to reach a definitive diagnosis, a bone biopsy should be taken for microscopy, culture, and histology. 4,10 Tuberculous bacilli are rarely seen (with Ziehl-Neelsen staining) or grown in culture, and the diagnosis often has to be made based on the granulomatous appearance histologically along with high clinical and radiographic suspicion. 4,8,9 Although surgical debridement is controversial for hand and wrist tuberculosis.…”

“…Even though reports about isolated tuberculosis infections of the wrist have increased, it remains rare condition which account for only 1% of the peripheral osteoarticular tuberculosis cases. 2,[4][5][6][7] Isolated tuberculosis infection of carpal bones is even more uncommon; to our knowledge this is the first report about an isolated tuberculosis of the capitate and triquetrum bone. 2,6,7 Case Report A 23-year-old male patient was referred to our clinic with pain, reduced range of motion, swelling, and a nonhealing sinus in the ulnar aspect of the left wrist joint.…”