A case published in the New England Journal of Medicine reports on an immunosupressed patient who developed tuberculosis (TB) of the finger.

The patient, a 42-year-old female with systemic lupus erythematosus treated with mycophenolate mofetil and prednisone, reported swelling and pain in the fifth finger of her left hand for about 1-week. Physical examination and imaging of the hand revealed the patient had swelling of the soft tissue, while a biopsy of the skin tissue showed numerous acid-fast bacilli; a culture of the sample confirmed the presence of Mycobacterium tuberculosis

Image courtesy: The New England Journal of Medicine ©2018.

While further investigation of the patient showed that she did not have active pulmonary TB, it was revealed that her husband had recently been diagnosed after returning from a trip to China. The patient received 9 months of treatment with a 4-drug anti-TB regimen which led to complete resolution of symptoms. According to the Centers for Disease Control and Prevention (CDC), the first-line anti-TB agents that make up the core of treatment regimens are: isoniazid, rifampin, ethambutol, and pyrazinamide

“Although infection of the finger is a rare extrapulmonary manifestation of tuberculosis, it is an important consideration in immunosuppressed patients,” concluded the authors. 

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