Abstract

Background: Metacarpals and phalanges are rarely affected in extrapulmonary tuberculosis. Tuberculous dactilytis is defined as infection of metacarpals, metatarsals, and phalanges of hands and feet in tuberculosis patients. About 85% of affected people with tubercular dactylitis are younger than 6 years old. As a result of the structure difference between pediatric and adult hand, the disease manifestation and the subsequent course differ substantially.

Case presentation: A 5-year-old female with isolated metacarpal bone involvement admitted to Children medical center Hospital, Tehran ,Iran. The patient history indicated a 6 months antibiotic therapy with no improvement. Based on radiological and sonographical evidences, a surgical intervention was implemented to remove the necrotic tissues and promote vascularization. The patient was discharged and prescribed Ethambutol/isoniazid/pyrazinamide/rifampicin and Vitamin B6 for six months.

Conclusion: The surgical debridement can be suggested as a first line treatment for TB dactilytis, when the bone is severely damaged. In such cases antibiotic therapy should be administered after the surgery.

Keywords: Tuberculous; Dactilytis; Infection; Bone; Debridement; Microbiology; Palliative care