case_images: PMC1310521_01
case_images: Left fifth digit with marked swelling. Photo taken after biopsy.
case_images: 1476-0711-4-18-1.jpg
case_images: PMC1310521_01_1476-0711-4-18-1.jpg
case_images: F1
case_images: On physical exam his fifth digit was swollen and erythematous at the proximal intraphalangeal joint [figure 1].
case_images: Plain radiograph of left hand demonstrated soft tissue swelling of the fifth digit, joint space narrowing with mottled lucency of the proximal phalanx, and cystic degenerative changes.
case_images: 1476-0711-4-18-2.jpg
case_images: PMC1310521_01_1476-0711-4-18-2.jpg
case_images: F2
case_images: Left hand radiography was significant for soft tissue swelling over the left finger with joint space narrowing and cortical lucencies with cystic degenerative changes in the proximal phalanx [figure 2].
case_images: Computed Tomography Scan of the chest showed mediastinal lymphadenopathy and multiple bilateral pulmonary nodules.
case_images: 1476-0711-4-18-3.jpg
case_images: PMC1310521_01_1476-0711-4-18-3.jpg
case_images: F3
case_images: Computed tomography scan of the chest revealed multiple pulmonary nodules [figure 3], necrotic lymph nodes, and splenomegaly.
case_images: Biopsy of synovial tissue revealed rare slightly curved acid fast bacilli (Ziehl-Neelsen stain; original magnification x1000).
case_images: 1476-0711-4-18-4.jpg
case_images: PMC1310521_01_1476-0711-4-18-4.jpg
case_images: F4
case_images: Rare acid-fast bacilli were demonstrated on biopsy of the both phalanx and synovial fluid samples [figure 4].
case_images: Culture on Lowenstein-Jensen medium revealed typical dry, heaped-up yellow to buff-colored colonies of Mycobacterium tuberculosis.
case_images: 1476-0711-4-18-5.jpg
case_images: PMC1310521_01_1476-0711-4-18-5.jpg
case_images: F5
case_images: Mycobacterium tuberculosis [figure 5]. Multiple Ziehl-Neelsen stains of induced sputum samples were negative for acid-fast bacilli, but all specimens sent for sputum culture grew Mycobacterium tuberculosis.
case_images: Follow-up photo of fifth digit 6 weeks after initiation of anti-tuberculous therapy.
case_images: 1476-0711-4-18-6.jpg
case_images: PMC1310521_01_1476-0711-4-18-6.jpg
case_images: F6
case_images: After 12 weeks of treatment, marked improvement in the finger lesion was noted [figure 6].