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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, Indiab Department of Orthopaedics, Era Medical College, Lucknow, India

Keywords:

Tuberculosis

Dactylitis

Granuloma

* Corresponding author. Tel.: þ91 964337832E-mail address: 86.khanna@gmail.com (V

Please cite this article in press as: Khann10.1016/j.apme.2014.07.001

http://dx.doi.org/10.1016/j.apme.2014.07.0010976-0016/Copyright © 2014, Indraprastha M

Fig. 1 e Clinical picture of the thumb showing a spindle

shaped swelling and a discharging sinus wound on the

thumb.

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 cellssuggestive 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

3.. Khanna).

a V, et al., Spina ventosa in an 18 year old, Apollo Medicine (2014), http://dx.doi.org/

edical Corporation Ltd. All rights reserved.

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 ) 1e22

Please cite this article in press as: Khanna V, et al., Spina ventos10.1016/j.apme.2014.07.001

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. Isolatedmetacarpal bone tuberculosis e a case report. Lung India.2008;25:17e19.

2. Gyanshankar PM, Dhamgaye TM, Amol BF. Spina ventosadischarging tubercle bacilli e a case report. Indian J Tuberc.2009;56(2):100e103.

3. Vaishya R. “A thorny problem”: diagnosis & treatment ofacacia thorn injuries. Injury. 1989;21:97e100.

a in an 18 year old, Apollo Medicine (2014), http://dx.doi.org/

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