A Rare Presentation of Hand TB Extending to the Space of Parona

Abstract

Most cases of hand infections are caused by gram-positive cocci and gram-negative bacilli. Atypical hand infections are rare and are caused by uncommon pathogens like Mycobacterium tuberculosis (TB). Musculoskeletal tuberculosis accounts for 20% of TB cases, and only 2% of these cases involve the hand and foot. In this article, we describe a case of hand TB that had spread from the thenar space to the space of Parona. The patient was treated with a combined surgical and medical approach. A 29-year-old male patient presented to our clinic with the complaint of pain and swelling of the right hand that had been worsening for 4 months before presentation. It was associated with mild weakness and night sweats. On physical examination, he had two separate swellings: one at the thenar eminence and one at the volar side of the wrist. He was taken for incision, which showed caseous material on both sites. It was sent for culture that revealed mycobacterium tuberculosis. The patient was placed on anti-TB medications for a total of 6 months. Tuberculous infection of the hand is a rare condition; the most common musculoskeletal sites are the spine, hip, and knee. Early diagnosis and treatment of TB infection in hand are essential for retaining optimal function. The diagnosis usually depends on the clinical presentation supported by laboratory tests and imaging studies. Treatment consists of medical, surgical, or combined treatment. Surgical intervention should aim to remove all the infected material in addition to debridement of the involved tissues.