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.

1.
Spin
na ventossa in an 1
8 year oldd

2. Case Report
Spina ventosa in an 18 year old
Vikram Khanna a,*
, Raju Vaishya a
, Vipul Vijay a
, Vivek Vaibhav b
a
Department of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India
b
Department of Orthopaedics, Era Medical College, Lucknow, India
Keywords:
Tuberculosis
Dactylitis
Granuloma
1. Description
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 progres-
sively increasing in size. She was also suffering from pulmo-
nary tuberculosis. Local examination revealed a spindle
shaped swelling of 3 cm  2 cm over the right 1st metacarpal.
This swelling was bony hard tender and was fixed to under-
lying bone with a pus discharging sinus (Fig. 1). X-ray showed
a cystic expansile lesion of right 1st metacarpal (Fig. 2). There
was an increase in ESR (24 mm at 1 h). Montoux test and
sputum for AFB were positive. Histopathological examination
revealed an epitheloid granuloma with Langhans' giant cells
suggestive of tuberculosis (Fig. 3).
She was given a course of antituberculosis treatment for 12
months. At 1 year follow up, the discharging sinus had healed
and the ESR had returned to normal, but the bony swelling had
persisted.
Tubercular dactylitis (spina ventosa) is an uncommon
presentation of tuberculosis. It is characterised radiologically
by spindle shaped cystic swelling of the short tubular bones.1
About 80e85% of cases occur below the age group of 6 years
Fig. 1 e Clinical picture of the thumb showing a spindle
shaped swelling and a discharging sinus wound on the
thumb.
* Corresponding author. Tel.: þ91 9643378323.
E-mail address: 86.khanna@gmail.com (V. Khanna).
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier.com/locate/apme
a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e2
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
http://dx.doi.org/10.1016/j.apme.2014.07.001
0976-0016/Copyright © 2014, Indraprastha Medical Corporation Ltd. All rights reserved.

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

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