Multifocal Tuberculous Dactylitis Involving the Hand and Foot in a Pre-adolescent Patient: A Case Report

While tuberculous (TB) dactylitis (spina ventosa) is traditionally recognized as an uncommon extrapulmonary manifestation in early childhood, its presentation in pre-adolescents remains exceptionally rare and diagnostically challenging. We report an unusual case in an 11-year-old boy who presented with a two-month history of insidious, painful, and progressive swelling of the right index finger and right foot. Initial antibiotic treatment at a local facility was unsuccessful. Physical examination revealed localized tenderness and restricted joint mobility. Laboratory investigations showed microcytic anemia and markedly elevated inflammatory markers (erythrocyte sedimentation rate (ESR) 120 mm/hr, C-reactive protein (CRP) 56 mg/L). Radiographic imaging identified characteristic expansile lytic lesions in the proximal phalanx and first metatarsal. The diagnosis was confirmed via fine-needle aspiration cytology (FNAC), which revealed acid-fast bacilli (AFB) on Ziehl-Neelsen staining. The patient was started on a standard four-drug anti-tubercular therapy (HRZE) regimen. This case underscores the importance of considering TB dactylitis in the differential diagnosis of chronic bone swelling in older children and multifocal presentations, especially in TB-endemic regions, to prevent diagnostic delays.