Disseminated Spina Ventosa in an Immunocompetent Young Girl

A 16-year-old immunocompetent girl presented with insidious onset, slowly progressive swelling over her right thumb and left hand since 3 months. She had a history of trauma 1 year back. Cutaneous examination revealed a diffuse, minimally tender, soft to firm, skin-colored, smooth swelling measuring 7 × 5 cm and 2 × 1 cm over the left dorsa of the hand and right thumb [Figures 1 and 2a]. The Mantoux test demonstrated a strong positive bullous reaction [Figure 2b]. X-ray of both hands depicted a lytic expansile lesion with periosteal reaction over the left metacarpal and right proximal phalanx [Figure 3]. Serology for the human immunodeficiency virus, hepatitis B and C were negative. The diagnosis of disseminated spina ventosa was made, and antitubercular therapy was initiated with complete resolution at 6 months of follow-up [Figure 4a and b].Figure 1: Clinical image shows diffuse nontender minimal erythematous to skin-colored swelling of left dorsa of hand with central ulceration and purulent dischargeFigure 2: (a) Clinical examination reveals fusiform swelling of right thumb with central puckered sinus. (b) Strong positive bullous Mantoux testFigure 3: Roentgenogram demonstrates lytic expansile lesion with periosteal reaction in right first proximal phalanx, and left middle metacarpalsFigure 4: (a) Clinical image depicts complete clearance after 6 months of therapy subsidence of swelling over the left hand, (b) resolution of swelling of right thumb after 6 months of treatmentTubercular dactylitis leads to endosteal destruction and subperiosteal new bone formation resulting in spindle-shaped ballooning of short bones referred to as the sausage digit or spina ventosa (Latin for wind-filled digit).[1] It is frequently seen in children. During the initial infection, untreated pulmonary tuberculosis spreads to the skeletal system through the lymphohematogenous route. Rarely, this can occur without any prior systemic involvement. Hand bones (mostly the proximal phalanx of the index and the middle finger) are more commonly affected than foot bones.[2] It has a good prognosis and responds to antitubercular treatment within 2-3 months.[2] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.