SHM Converge Scientific Abstract ePoster Gallery-Tuberculosis Dactylitis in an Adult With Recurrent Digital Trauma Due to Autophagia

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This case report describes a 61-year-old man with diabetes, neuropathy, and a history of recurrent self-inflicted digital trauma from finger chewing/autophagia who presented with swelling, erythema, drainage, numbness, and necrosis of the right second finger, along with similar necrotic changes in another digit. Imaging suggested multifocal osteomyelitis, and he underwent partial amputation. Initial wound culture grew MSSA, so he was treated as a bacterial infection.<br /><br />After discharge, the amputation specimen later returned AFB-positive for Mycobacterium tuberculosis, and pathology showed necrosis, granulation tissue, extensive inflammation, cellulitis, and acute osteomyelitis. He was recalled for evaluation of tuberculous dactylitis. Despite major weight loss, he had no known TB exposures. Workup including QuantiFERON, HIV, hepatitis testing, MTB PCR, blood cultures, and sputum AFB smears/cultures was negative. CT chest showed only two small pulmonary nodules. MRI of the hand demonstrated cellulitis and marrow edema consistent with infection.<br /><br />He was discharged on a prolonged multidrug anti-tuberculous regimen (isoniazid, rifampin, pyrazinamide, ethambutol, plus pyridoxine) and levofloxacin for concurrent MSSA osteomyelitis, with close public health follow-up.<br /><br />The report emphasizes that tuberculous dactylitis is a rare extrapulmonary TB infection, usually seen in children but occasionally in adults. In adults, it can closely mimic bacterial osteomyelitis, especially when routine tests are negative and there is concurrent bacterial growth or traumatic inoculation. Diagnosis often depends on biopsy and culture rather than screening tests alone. The authors stress that TB should remain on the differential for chronic or atypical digital infections, particularly when the clinical course is unusual or refractory.

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Tommy Ojukwu Perdomo

Meta Tag

Author List Bhavik Patel, Manoj Trehan, Rita Njoh, Syed Ali, Theodore Patsis, Tommy Ojukwu Perdomo

Category Clinical Vignettes

Concept Tuberculous Dactylitis

Concept Extrapulmonary Tuberculosis

Concept Anti-tuberculosis Regimen

Concept Osteomyelitis

Concept Tissue Culture

Distinguished Non-Finalist

Presenter Organization Department of Medicine, NYU Langone Hospital – Suffolk, Patchogue, NY

Presenting Author Tommy Ojukwu Perdomo

Track Adult

Keywords

tuberculous dactylitis

Mycobacterium tuberculosis

osteomyelitis

digital infection

finger autophagia

partial amputation

AFB-positive

extrapulmonary tuberculosis

MSSA coinfection

biopsy culture

Tuberculous Dactylitis

Extrapulmonary Tuberculosis

Anti-tuberculosis Regimen

Osteomyelitis

Tissue Culture