PMC1310521_01
Left fifth digit with marked swelling. Photo taken after biopsy.
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F1
On physical exam his fifth digit was swollen and erythematous at the proximal intraphalangeal joint [figure 1].
Plain radiograph of left hand demonstrated soft tissue swelling of the fifth digit, joint space narrowing with mottled lucency of the proximal phalanx, and cystic degenerative changes.
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F2
Left hand radiography was significant for soft tissue swelling over the left finger with joint space narrowing and cortical lucencies with cystic degenerative changes in the proximal phalanx [figure 2].
Computed Tomography Scan of the chest showed mediastinal lymphadenopathy and multiple bilateral pulmonary nodules.
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F3
Computed tomography scan of the chest revealed multiple pulmonary nodules [figure 3], necrotic lymph nodes, and splenomegaly.
Biopsy of synovial tissue revealed rare slightly curved acid fast bacilli (Ziehl-Neelsen stain; original magnification x1000).
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F4
Rare acid-fast bacilli were demonstrated on biopsy of the both phalanx and synovial fluid samples [figure 4].
Culture on Lowenstein-Jensen medium revealed typical dry, heaped-up yellow to buff-colored colonies of Mycobacterium tuberculosis.
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F5
Mycobacterium tuberculosis [figure 5]. Multiple Ziehl-Neelsen stains of induced sputum samples were negative for acid-fast bacilli, but all specimens sent for sputum culture grew Mycobacterium tuberculosis.
Follow-up photo of fifth digit 6 weeks after initiation of anti-tuberculous therapy.
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F6
After 12 weeks of treatment, marked improvement in the finger lesion was noted [figure 6].