Volume 3 • Issue 4 • 1000147 J Cytol Histol ISSN: 2157-7099 JCH, an open access journal Research Article Open Access Bhuyan et al., J Cytol Histol 2012, 3:4 DOI: 10.4172/2157-7099.1000147 Case Report Open Access Cytodiagnosis of Tubercular Dactylitis with Skin and Lymph Node Lesions in an Immunocompetent Patient Smita Mahapatra 1 *, Sitaram Mahapatra 1 , Pallavi Bhuyan 1 , Kaumudee Pattnaik 1 and Ashoka Mahapatra 2 1 Department of Pathology, S.C.B. Medical College, Cuttack, Odisha, India 2 Department of Microbiology, S.C.B. Medical College, Cuttack, Odisha, India *Corresponding author: Smita Mahapatra, Department of Pathology, S.C.B. Medical College, Cuttack, Odisha, India, 751015, Tel: 91-9437094138; E-mail: doctorsmita@rediffmail.com Received May 19, 2012; Accepted June 29, 2012; Published July 02, 2012 Citation: Mahapatra S, Mahapatra S, Bhuyan P, Pattnaik K, Mahapatra A (2012) Cytodiagnosis of Tubercular Dactylitis with Skin and Lymph Node Lesions in an Immunocompetent Patient. J Cytol Histol 3:147. doi:10.4172/2157-7099.1000147 Copyright: © 2012 Bhuyan P, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Tubercular dactylitis is an extremely rare entity. To the best of our knowledge, we are reporting for the frst time tuberculosis of phalanx along with cutaneous nodule and lymph nodes in an immunocompetent patient even in absence of a detectable primary focus. A 35 year old male presented with a hard swelling in proximal phalanx of left ring fnger. He had a cutaneous nodule on right index fnger and enlarged epitrochlear and axillary lymph nodes on the ipsilateral side. In X- Ray, a lytic lesion destroying whole proximal phalanx was seen with chest X- Ray being normal. HIV ELISA was negative. Cytology from cutaneous nodule and lymph nodes depicted the picture of a granulomatous lesion. Biopsy, culture of bone tissues and polymerase chain reaction confrmed the lesions to be tubercular. Tubercular dactylitis along with other tubercular lesions is an extremely rare condition and the lesions must be differentiated from other granulomatous conditions to advocate specifc therapy. Keywords: Tubercular dactylitis; Cutaneous nodule; Lymph node Introduction Tubercular involvement of phalanx is an unusual presentation [1,2]. In skeletal involvement, spine is the most frequent site [3]. Tubercular dactylitis, although most frequently encountered in children, also occurs in adults [4]. Tubercular lesions taken together in an immunocompetent patient involving phalanx, cutaneous nodule, axillary and epitrochlear lymph nodes has not been yet reported in the literature although, tubercular dactylitis along with cutaneous involvement has already been established [5]. In our case, there was tubercular involvement of multiple sites without any pulmonary involvement in an HIV negative patient. Case Report A 35-year-old male presented with a hard swelling of 2 cm diameter involving proximal phalanx of lef ring fnger of 2 months duration (Figure 1). On examination, there was also a cutaneous nodule of 0.5 cm, over the base of right index fnger and had enlarged, mobile epitrochlear and axillary lymph nodes of about 2 cm, on the ipsilateral side. Tere was no history of recent trauma to the fnger, fever, weight loss, cough and tingling sensation. On examination, he had no hypopigmented patch or nerve thickening. All the hematological parameters were within normal limits besides raised ESR of 90 mm in 1 st Hr (Westergren) and Mantoux test of 25 mm. Sickling test was negative. X- Ray revealed lytic lesion destroying whole proximal phalanx of lef ring fnger (Figure 2). Chest X- Ray was normal. X- Ray of right hand revealed no bony abnormality and it was a sof tissue swelling. Blood, throat swab and urine cultures were sterile. Multiple Ziehl-Neelsen (Z-N) stain of induced sputum samples was negative for acid- fast bacilli. Rheumatology serology (ANA, Anti- ds DNA, P- ANCA, C- ANCA), syphilis serology, HIV ELISA was negative. In Fine Needle Aspiration (FNA) of proximal phalanx of lef ring fnger swelling revealed epithelioid cell clusters, caseating necrosis, multinucleated giant cells and few osteoblasts (Figure 3). FNA of both epitrochlear and axillary lymph nodes showed caseating necrosis, epithelioid cells and Langhans giant cells in the background of lymphoid cells and cutaneous nodule had a similar picture of granulomatous Figure 1: A swelling in proximal phalanx of left ring fnger and a subcutaneous nodule over base of right index fnger. Figure 2: X-Ray of left hand showing lytic lesion destroying proximal phalanx of left ring fnger. J o u r n a l o f C y t o l o g y & H i s t o l o g y ISSN: 2157-7099 Journal of Cytology & Histology