# Tuberculous Osteomyelitis in the Hand

## TL;DR

A young man with no known tuberculosis risk factors developed a rare bone infection in his hand caused by tuberculosis.

## Contribution

This case report presents an unusual instance of tuberculous osteomyelitis in a small hand bone of an immunocompetent young adult.

## Key findings

- Tuberculous osteomyelitis was diagnosed in a 22-year-old man with localized hand swelling and no systemic symptoms.
- PCR testing confirmed Mycobacterium tuberculosis in bone and soft tissue samples from the affected hand.
- The case emphasizes the need to consider tuberculosis in differential diagnoses for localized bone infections without clear risk factors.

## Abstract

Tuberculous osteomyelitis is recognized as a rare form of extrapulmonary tuberculosis, particularly when involving the small bones of the hand in adults. Early diagnosis is challenging due to its uncommon presentation and nonspecific symptoms. These factors often contribute to the delayed identification and management of the condition.

We report a 22-year-old male construction worker from Mexico who presented with swelling and pain localized to his right hand. One week prior to presentation, he experienced minor blunt trauma to the fifth metacarpal region when a piece of wood struck his hand, with no skin breach. He denied any systemic symptoms such as fever or weight loss. Additionally, there was no history of incarceration, overcrowded living conditions, or known tuberculosis exposure. Imaging studies revealed extensive pathology in the chest and hand. Bone and soft tissue samples from the hand tested positive for acid-fast bacteria (AFB) and Mycobacterium tuberculosis (TB) by polymerase chain reaction (PCR). This case highlights an unusual presentation of tuberculous osteomyelitis involving a small hand bone in a young, immunocompetent patient.

The report emphasizes the importance of comprehensive diagnostics when evaluating patients with localized swelling and no clear entry site. Tuberculosis should be considered in the differential diagnosis even without systemic symptoms.