TB dactylitis in a toddler

A well-thriving male toddler presented with a painless swelling on the dorsal surface of his right hand , incidentally noticed by the mother. There was no history of local trauma or any systemic symptoms . On examination, there were no signs of inflammation over the swelling. An X-ray was taken , and an expansile lytic lesion of the right fifth metacarpal bone was seen. He underwent debridement , and the tissue was sent for histopathological examination ( HPE ) and cartridge-based nucleic acid amplification t est ( CBNAAT ) for Mycobacterium tuberculosis ( M. tb ). HPE revealed ill-defined granulomas and multinucleated giant cells , and CBNAAT was positive for M. tb - rifampicin sensitive . The child was started on anti tubercular therapy. He is doing well on follow-up . Awareness of this presentation of tuberculous dactylitis and its timely diagnosis will help in minimising complications and facilitate complete resolution of the infection.