CTICasesPulmonary Tuberculosis Presenting as Digital Osteomyelitis
[...]. Pulmonary Tuberculosis Presenting as Digital Osteomyelitis. CTICases. Published September 11, 2026. https://cticases.com/c/mpw8f
Imaging findings
A 26-year-old man presented with a swollen finger. The hand radiograph showed soft tissue edema around the distal phalanx with frank osteolysis destroying the bone, without the periarticular erosion pattern of an inflammatory arthropathy, leaving tumor, infection and trauma on the differential. He failed conservative management and antibiotics for a presumed soft tissue infection, and the digit was biopsied because a mass was suspected. Histology returned necrotizing granulomatous inflammation and cultures eventually grew Mycobacterium tuberculosis. A chest radiograph obtained three to four weeks later showed cavitary disease with associated nodules, indicating established and contagious pulmonary tuberculosis that had gone unrecognized while the finger was being investigated.
Key takeaways
Skeletal tuberculosis is hematogenous, so the lung is the portal of entry and a phalangeal lesion is a distant seed rather than the primary site. A chest radiograph belongs early in the workup of any lytic bone lesion that returns necrotizing granulomatous inflammation, and it was only obtained here after the organism had been identified. As in Pott disease, tuberculous osteomyelitis can involve a single site with no other apparent focus, and a patient with cavitary pulmonary disease may report no cough, which does not make the lungs clear.
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