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SAT0493 Tuberculosis of The Hand: Clinical Presentation and Treatment
  1. M.A. Sbai1,
  2. H. Sahli2,
  3. W. Khoffi1,
  4. A. Ben Tekaya3,
  5. R. Tekaya3
  1. 1Traum Department
  2. 2Rhumatology Department, Mohamed Taher Maamouri University Hospital, Nabeul
  3. 3Rhumatology Department, Charles Nicolle Hospital, Tunis, Tunisia

Abstract

Background The tuberculosis remains one of the most world wide spread infectious diseases. The ostéoarticular localization is rare, affecting the hand remains exceptional. The incidious presentation, the poor symptomatic character of the tubercular dactylitis may explain the constant delay in the diagnosis. It is often delayed and confused essentially with bone tumors which imply histological confirmation.

Objectives To study the epidemio-clinical features, stages, therapeutics and course of tuberculosis of the hand.

Methods We made a retrospective study of 14 medical records of cases of tuberculosis involving the hands in an orthopedic department over the last ten years. We collected and analyzed the clinical, bacteriological, radiological and therapeutic data.

Results The mean age was 45 years. There were 9 men and 5 women. A manual work was noted in 10 cases. Two patients had a diabetes mellitus and one breast cancer. The dominant side was achieved in 60% of cases. Mean symptoms duration was 3.6 months. Lesions are divided into 6 cases of pseudotumoral tuberculosis of soft tissue of the hand, arthritis and osteoarthritis in 5 cases and tenosynovitis in 3 cases. The ring and little fingers are the most affected fingers. Biopsy was done in all cases. Anti-tubercular chemotherapy was indicated for all patients: isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months followed by isoniazid and rifampicin during 10 months. These antibiotics were combined with immobilization in all cases. Good outcome was seen in the 14 cases.

Conclusions Tuberculosis should be suspected in cases of longstanding pain and swelling of a finger especially in an endemic area. Efficiency of anti-tubercular treatment remains undisputed. The surgical indications are limited to the biopsy, usually essential to the diagnosis.

Disclosure of Interest None declared

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