Mohammad H. Derakhshan et al. and secondary care: only one-third of patients are system/uploads/attachment_data/file/215946/dh_124048. managed in rheumatology. Rheumatology 2016;55: pdf (1 June 2017, date last accessed). 18205. 31 National Ankylosing Spondylitis Society. 20152019 30 Department of Health. Personalised care planning: infor- Strategy. http://nass.co.uk/about-nass/20152019-strat- mation sheet 1. https://www.gov.uk/government/uploads/ egy/ (1 June 2017, date last accessed). Rheumatology 2018;57:996 doi:10.1093/rheumatology/kex398 Clinical Vignette Advance Access publication 25 October 2017 Spina ventosa: an uncommon case report of 12-month regimen of isoniazidrifampicin is the most rec- primary tuberculosis infection ommended treatment for extrapulmonary tuberculosis. Surgical excision can be necessary [1, 2]. Tuberculous dactylitis is rare. Because of its radiographical cystic expansion, it is called spina ventosa (SV) [1, 2]. Our Funding: No specific funding was received from any 50-year-old patient presented with spontaneous and insidi- bodies in the public, commercial or not-for-profit sectors ous finger swelling, fever and night sweats of 7 months. His to carry out the work described in this manuscript. digit was painful and erythematous (Fig. 1A). Laboratory’s Disclosure statement: The authors have declared no inflammation, virus, RF and brucella tests were normal but conflicts of interest. the Mantoux test was positive. An X-ray showed proximal phalanx lytic lesion (Fig. 1B). US showed synovium thicken- 1 1 Sonia Rekik , Lobna Ben Ammar , ing with Doppler hypervascularization of MCP, proximal 1 2 1 Boussaid Soumaya , Alia Zehani ,Hela Sahli , PIP and flexor tenosynovitis. Biopsy revealed epithelioid- 1 1 Ilhem Cheour , Mohamed Elleuch and gigantocellular granulomas with necrosis. No other tubercu- Mohamed Ben Amor lar sites were found. Anti-tubercular chemotherapy provided full recovery and improvement in radiological signs (Fig. 1C). Rheumatology Departement, La Rabta Hospital, 2 3 Anatomopathology Department, Hospital La Rabta and ENT SV has a dactylitis aetiology affecting hands more often Departement, Hopital La Rabta, Tunis, Tunisie than feet. The proximal phalanges of the index and middle fingers are the commonest sites. Over 50% of patients Correspondence to: Sonia Rekik, Service de Rhumatologie, have no evidence of active pulmonary tuberculosis. Hopital La Rabta, Rue Jabbari, 1007, colline La Rabta, Tunis, Tunisie. Spread to the skeletal system occurs via the lympho- E-mail: firstname.lastname@example.org haematogenous route . Bone tumour, pyogenic osteomyelitis, rheumatoid or PsA and syphilitic dactylitis can present with cystic References changes and mimick SV. Mycobacterium tuberculi isola- 1 Chowdhary V, Aggarwal A, Misra R. Multifocal tubercular tion, PCR or biopsy support diagnosis. Serious conse- dactylitis in an adult. J Clin Rheumatol 2002;8:357. quences, such joint ankylosis, can occur if diagnosis is delayed. A 2-month initial phase of isoniazidrifampi- 2 Fairag R, Hamdi A. Tuberculous dactylitis: case presentation cinpyrazinamideethambutol followed by a 6- to and functional outcome. J Orthop Case Rep 2016;6:224. FIG.1 Tubercular dactylitis resulting in erythema and swelling of the fourth finger, and significant improvement after anti- tubercular treatment (A) A firm swelling of the left fourth finger involving the MCP joint and the proximal phalanx. (B) X-ray of the finger showing expansile lytic lesion, sclerosis and soft tissue swelling in the middle part of proximal phalanx of the fourth finger with periosteal reaction (arrow). (C) Significant improvement in the swelling and decreased stiffness after anti-tubercular chemotherapy. ! The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: email@example.com 996 https://academic.oup.com/rheumatology Downloaded from https://academic.oup.com/rheumatology/article-abstract/57/6/996/4565531 by Ed 'DeepDyve' Gillespie user on 17 June 2018
Rheumatology – Oxford University Press
Published: Oct 25, 2017
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