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Tuberculosis of the finger: Woman suffers rare symptom of infection
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Physicians in San Francisco reported a rare extrapulmonary manifestation of tuberculosis: infection of the finger.
According to a brief report published in The New England Journal of Medicine, an immunosuppressed woman aged 42 years being treated for systemic lupus erythematosus presented with a 1-week history of swelling and pain in the fifth finger of her left hand. The report, by clinical fellow Jennifer Mandal, MD, and associate professor Mary Margaretten, MD, both of the University of California, San Francisco, noted that the woman reported no related trauma.
According to Mandal and Margaretten, the patient had tested negative for TB via a purified protein derivative skin test before initiating immunosuppressive therapy. But physicians discovered that her husband was diagnosed with active pulmonary TB after returning home from a recent trip to China.
A physical examination of the woman’s finger showed soft-tissue swelling, erythema and warmth, Mandal and Margaretten reported. Imaging showed swelling of the soft tissue but no bony abnormalities, they said.
According to the report, “a biopsy specimen of the deep dermis after Fite staining revealed numerous acid-fast bacilli” and a tissue sample culture grew Mycobacterium tuberculosis. A chest radiograph was normal.
The patient’s symptoms resolved following 9 months of treatment with a four-drug anti-TB regimen, Mandal and Margaretten said.
“Although infection of the finger is a rare extrapulmonary manifestation of tuberculosis, it is an important consideration in immunosuppressed patients,” they wrote. – by Marley Ghizzone
Disclosure: The authors report no relevant financial disclosures.
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