A 2 year old boy was presented with a swelling of right middle metacarpal for last 4 months. The swelling was initially small gradually increasing in size. It was associated with dull aching pain for the last 3 months. There was no history of any trauma. However, h/o exposure to pulmonary tuberculosis was present.
On examination, a semi tubular swelling 5cm *2cm was noted over right 3rd metacarpal. The swelling was bony hard, fixed to underlying bone, tender and local temperature slightly raised.
A radiograph of the right hand showed a cystic expansile lesion of right 3rd metacarpal. The margins were well defined with internal septations and associated cortical sclerosis. There was cortical destruction but no periosteal reaction.
A provisional diagnosis of enchondromata was made, while tuberculous dactylitis was kept in mind. Differential diagnoses were osteoblastoma, syphilis. The boy was recommended for surgery and excision of 3rd metacarpal was done followed by strut graft from ipsilateral fibula. The specimen sent for HPE showed epitheloid granuloma suggestive of tuberculosis. Mantoux test was positive and sputum for AFB also revealed positive result (Figs. 1, 2).