An unusual cause of finger swelling

Description

A 7-year-old South Asian boy was evaluated in a district general child assessment unit following a 4-week history of daily fevers with associated pain and swelling in the thumb and middle finger phalanges of the right hand. There was no history of cough, weight loss, night sweats or trauma. On examination, he appeared well with no anaemia or jaundice. There was a spindle-shaped deformity of the right thumb and middle finger, with concomitant non-tender right axillary lymphadenopathy. No other joints were affected. The rest of the physical examination was unremarkable.

Radiographs of the affected fingers demonstrated fusiform soft tissue swelling (Figure 1A) with smooth periosteal reaction (Figure 1B). Subsequent CT of the thorax demonstrated necrotic axillary (Figure 2A) and hilar lymphadenopathy (Figure 2B) with 'tree-in-bud' change in the superior segment of the left lower lobe (Figure 1C).

...

http://ift.tt/2uJ3lHu