Disseminated tuberculosis presenting as finger swelling in a 2-year-old: a case report of TB osteomyelitis

Tuberculosis (TB) is a chronic granulomatous infection caused by Mycobacterium tuberculosis. TB primarily affects the lungs. A small percentage of cases are associated with extrapulmonary TB (EPTB). Of all EPTB, skeletal TB accounts for 1-5% of the cases, with the vertebrae being the most commonly affected. Involvement of the hands usually occurs in children under the age of six, with the bones of the proximal phalanx of the middle and index fingers being the most reported sites of infection. We describe a case of disseminated TB presenting as swelling in the index finger. Due to its nonspecific symptoms and insidious course, this condition is frequently overlooked. The presented case is unique compared to other documented TB cases as the child did not undergone Bacillus Calmette–Guérin (BCG) vaccination, a factor that might have contributed to the disease progression. Additionally, traditional cauterization was noted in the patient’s history, a practice that could complicate the diagnosis. Physicians should consider TB osteomyelitis when encountering young patients with finger swelling, particularly in endemic areas. Prompt recognition and diagnosis of TB osteomyelitis are crucial for early intervention and better outcomes.

结核病（Tuberculosis, TB）是由结核分枝杆菌（Mycobacterium tuberculosis）引发的慢性肉芽肿性感染，主要累及肺部。仅少数病例会并发肺外结核（extrapulmonary TB, EPTB）。在所有肺外结核病例中，骨结核占比1%~5%，其中以脊柱受累最为常见。手部结核通常发生于6岁以下儿童，最常受累的部位为中指与食指的近节指骨。本文报告1例以食指肿胀为表现的播散性结核病病例。由于该病症症状缺乏特异性且病程隐匿，常被漏诊。本病例与既往报道的结核病例存在独特性：该患儿未接种卡介苗（Bacillus Calmette–Guérin, BCG），这一因素可能促进了疾病进展；此外，患者病史中存在传统烧灼治疗史，该操作可能增加诊断难度。临床医师在接诊年轻手指肿胀患者时，尤其是在结核病流行地区，需将结核性骨髓炎纳入鉴别诊断范围。快速识别并确诊结核性骨髓炎，对于早期干预与改善预后至关重要。