Metacarpal tuberculosis is rare even in endemic areas. This is a report of a 12-year-old girl with gradual, painless swelling of the dorsal aspect of the right hand over a 2-year period. She developed a discharging sinus over the mass after a traumatic incident. The radiographs showed a well-defined, expansile osteolytic lesion. Blood test, fine needle aspiration biopsy and smears were not diagnostic. A second histologic examination with phenotypic test was required for diagnosis and to begin appropriate chemotherapy. Establishing the diagnosis was not straightforward, even though we suspected tuberculosis. Level of Evidence: Level V (Therapeutic).
Keywords: Hand; Metacarpal; Osteomyelitis; Paediatrics; Spina ventosa; Tuberculosis.