An 18 year old female presented with painless swelling and a chronic discharging sinus at the base of right thumb for last 6 months. The swelling was insidious in onset and progressively increasing in size. She was also suffering from pulmonary tuberculosis.
3. and the incidence of spina ventosa in children with tubercu-
losis is 0.65%e6.9%.2
Our case was unusual being 18 year old
which is rare because spina ventosa is generally seen in
children in whom the blood supply to the bones is profuse and
better than that in adults. We believe, that in our case since
there was considerable bacterial load, the tubercular infection
could lodge and flare even in a small tubular bone in this
adolescent girl causing dactylitis. Despite a full control of
infection, the bone swelling persisted as these lesions
heal with sclerosis. Tubercular dactylitis can mimic other
conditions like inflammatory lesions (pyogenic infection,
syphilis, brucellosis, sarcoidosis), neoplastic conditions
(enchondroma, fibrous dysplasia) and foreign body pricks
(thorn, wooden splinters).3
Awareness about this condition
and high index of suspicion is required to establish an early
diagnosis.
2. Learning points/take home message
Spina ventosa or tubercular dactylitis can present as
painless swelling of the digits, in isolation or in a dessi-
minated form.
Awareness about this condition is necessary to reach to an
early diagnosis.
Radiologically, there is often fusiform expansion of the
involved short tubular bone.
Conflicts of interest
All authors have none to declare.
r e f e r e n c e s
1. Kushwaha R, Kant S, Verma SK, Mehra S, Mehra S. Isolated
metacarpal bone tuberculosis e a case report. Lung India.
2008;25:17e19.
2. Gyanshankar PM, Dhamgaye TM, Amol BF. Spina ventosa
discharging tubercle bacilli e a case report. Indian J Tuberc.
2009;56(2):100e103.
3. Vaishya R. “A thorny problem”: diagnosis treatment of
acacia thorn injuries. Injury. 1989;21:97e100.
Fig. 2 e X-ray showing spindle shaped expansion of the 1st
metacarpal.
Fig. 3 e Histopathological image shows epitheloid
granuloma of tuberculosis.
a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e22
Please cite this article in press as: Khanna V, et al., Spina ventosa in an 18 year old, Apollo Medicine (2014), http://dx.doi.org/
10.1016/j.apme.2014.07.001