Case1

PRESENTATION:

5O Years old female patient presented with swelling around the

posterior aspect of the right hand since 1 year. The swelling

followed by the discharge since 5 months and the pain on and

off around the wound and also the dark discoloration of the

surrounding skin. The discharge is serous type with no any

 blood, pus or any smell. There is no history of any specules,

bony fragments,granules in discharge.

   No history of any trauma, any wound over that area before. No history of any other bony swellings.

No history of any joint pains or joint stiffness. No history of any constitutional symptoms.

No history of any massages or other treatment other than analgesics.

EXAMINATION:

     Swelling around 5/5cms on dorso lateral aspect of right hand,with ulcer of 2/3cms ovoid shape with granulationtissue.

     No any active discharge, sclerosed margins with hyper pigmented surroundings.

     Base of ulcer is the 5th metacarpal and floor by the dorsal interossei muscles.

     Deep bony tendernss present.

     No distal neurovascular deficit.

Investigations:

   CBP: Hypochromic normocytic anemia.DLC-normal

   ESR: 60 mm 1st hr.

Procedure:

   Curettage done and the tissue sent for histopathology.

REPORT:

    Tissue suggesting of chronic granulamatous infection, tuberculous origin.

DIAGNOSIS:

   TUBERCULOUS OSTEOMYELITIS OF 5TH METACARPAL .