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A Rare Localization of Caseating Tuberculous Nodule of Metacarpal: A Case Report

N Venkata Abinaya and G Venugopal

A typical tuberculous infection involving metacarpals and wrist is a very rare representation in both low and high income countries. This was the first case to be investigated in India, where a 57 year old male presented initially with a ganglion cyst affecting the right dorsum of the hand which was symptomless, soft and cystic on local examination .By performing USG guided Fine Needle Aspiration Cytology (FNAC); the features were compatible with infected Ganglion cyst which was excised and treated. After a month, the swelling reappeared in the same region (near 3rd metacarpal and wrist in the right dorsum of the hand), which was painful on movement. There was no positive sign on Chest x-ray or X-ray of the joint. By performing MRI, it revealed a subcutaneous edema involving the right dorsum of the hand and FNAC results revealed caseating and non caseating granulomas composed of epithelial cells, Langhan cells andcuff of lymphocytes ,with extensive fibrosis seen surrounding the caseous area and confirming it to be Caseating Tuberculous Nodule. Since it was diagnosed at an early stage, First line Anti- Tuberculosis drugs were given and the patient’s response to the treatment was satisfactory, with consequent reduction in the size of the swelling.
Conclusion: Early diagnosis and Prompt treatment in case of a prolonged swelling involving the hand and wrist joints which shows no prominent symptoms are essential to treat with caution in order to restore the function of the joint.