[Multifocal tuberculous dactylitis: a case report].
BACKGROUND
Tuberculous dactylitis (TD) is a rare disorder. It is the source of a diagnostic hardship as it is difficult to distinguish from other lesions. We report an unusual case with multiple affected sites both in hands and the right big toe.


METHODS
A 42-year-old female initially presented with two painful tumefactions affecting the left third finger and the right middle finger. These tumefactions had been present for two months. Conventional radiography and computed tomography of the hand revealed soft tissue swelling with bone expansion and cortical destruction in the proximal, middle and distal phalanx of the third finger, the proximal phalanx of the middle finger in the left hand, the proximal and middle phalanx of the middle finger of the right hand. Bone scintigraphy showed additionally infraradiologic localisation in the proximal phalanx of the first right toe. Pathology examination of a biopsy specimen revealed granulomatous osteitis with caseous necrosis. Antituberculosis treatment led to initial clinical remission followed by a recurrence and lesion spreading due to bacteria resistance. The second line treatment with Rifampicine, Ciprofloxacine, Ethambutol and Clarithromycine induced favorable outcome.


CONCLUSIONS
Tuberculosis dactylitis is well tolerated for a long time leading to a late diagnosis which may favour its spreading. Antituberculosis treatment is effective but the functional outcome depends on early diagnosis.
Service de Rhumatologie, EPS de Monastir, Monastir, Tunisia. saoussenzrour@yahoo.fr
S
S
Hassen-Zrour
M
M
Younes
M
M
Haj Salah-Othman
W
W
Korbäa
M
M
Touzi
I
I
Béjia
N
N
Bergaoui
M F
MF
Hamdi
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001706:Biopsy; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000627:therapeutic use; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D050278:Finger Phalanges / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage / Q000627:therapeutic use; D010000:Osteitis / Q000000981:diagnostic imaging / Q000473:pathology; D010020:Osteonecrosis / Q000473:pathology; D011718:Pyrazinamide / Q000008:administration & dosage / Q000627:therapeutic use; D011877:Radionuclide Imaging; D012008:Recurrence; D012074:Remission Induction; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors; D050277:Toe Phalanges / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014394:Tuberculosis, Osteoarticular / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D011718:Pyrazinamide; D002939:Ciprofloxacin; D004977:Ethambutol; D017291:Clarithromycin; D007538:Isoniazid; D012293:Rifampin