Patient Develops Rare Extrapulmonary Manifestation of Tuberculosis

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. 

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. 

For more information visit NEJM.org.