Cytodiagnosis of Tubercular Dactylitis with Skin and Lymph Node Lesions in an Immunocompetent Patient

Tubercular dactylitis is an extremely rare entity. To the best of our knowledge, we are reporting for the first time tuberculosis of phalanx along with cutaneous nodule and lymph nodes in an immunocompetent patient even in absence of a detectable primary focus. A 35 year old male presented with a hard swelling in proximal phalanx of left ring finger. He had a cutaneous nodule on right index finger and enlarged epitrochlear and axillary lymph nodes on the ipsilateral side. In X- Ray, a lytic lesion destroying whole proximal phalanx was seen with chest X- Ray being normal. HIV ELISA was negative. Cytology from cutaneous nodule and lymph nodes depicted the picture of a granulomatous lesion. Biopsy, culture of bone tissues and polymerase chain reaction confirmed the lesions to be tubercular. Tubercular dactylitis along with other tubercular lesions is an extremely rare condition and the lesions must be differentiated from other granulomatous conditions to advocate specific therapy.