Spina Ventosa of the Second Metacarpal in a Child Without Pulmonary TB: A Case Report
- A five-year-old Indian girl has been successfully diagnosed and treated for a rare case of skeletal tuberculosis strictly confined to her second metacarpal, completely devoid of any pulmonary...
- In the fall of 2024, the child’s father brought her to an outpatient department.
- Tuberculosis affecting the small bones of the hand—medically known as tuberculous dactylitis or spina ventosa—is exceptionally rare in children.
A five-year-old Indian girl has been successfully diagnosed and treated for a rare case of skeletal tuberculosis strictly confined to her second metacarpal, completely devoid of any pulmonary or systemic involvement. Published September 30, 2026, in the journal Cureus (DOI: 10.7759/cureus.117263), the case study centers on a young patient who presented with localized pain and swelling over the dorsum of her right hand. The finding highlights the profound diagnostic hurdles clinicians face when pediatric bone infections manifest without the hallmark constitutional symptoms or lung disease typically associated with the condition.
Two Months of Unexplained Hand Pain and Swelling
In the fall of 2024, the child’s father brought her to an outpatient department. She had been suffering from a dull, aching pain and swelling over the dorsum of her right hand for two months. Upon examination, the medical team noted neither erythema nor a discharging sinus at the site. The child also carried no history of trauma, tuberculosis exposure, sick contacts, or the constitutional symptoms that normally point toward the disease.
The Diagnostic Puzzle of Tuberculous Dactylitis
Tuberculosis affecting the small bones of the hand—medically known as tuberculous dactylitis or spina ventosa—is exceptionally rare in children. It frequently masquerades as other infective, inflammatory, or neoplastic conditions.
Authors Sankalp Yadav, Amruta Nadar, Madhan Jeyaraman, Gautam Rawal, and Naveen Jeyaraman note that extrapulmonary tuberculosis accounts for roughly 10% to 15% of all tuberculosis cases. It can infiltrate the musculoskeletal system via lymphohematogenous dissemination during a primary infection. Strikingly, approximately 85% of tuberculous dactylitis cases strike children under six years of age.
Targeted Molecular Testing and Weight-Based Therapy
Because the clinical features offered no clear answers and the lungs remained entirely unaffected, securing a definitive diagnosis demanded specialized molecular testing. Clinicians turned to a cartridge-based nucleic acid amplification test, which definitively confirmed the presence of Mycobacterium tuberculosis.
This laboratory breakthrough enabled the medical team to immediately launch timely, weight-based antituberculous therapy for the young patient. The study’s authors stress that physicians must maintain a high index of clinical suspicion for skeletal tuberculosis in pediatric patients presenting with persistent, unexplained hand swelling—even when chest examinations and pulmonary histories turn up zero signs of disease.