Tuberculous Osteomyelitis in the Hand.

Tuberculous osteomyelitis is recognized as a rare form of extrapulmonary tuberculosis, particularly when involving the small bones of the hand in adults. Early diagnosis is challenging due to its uncommon presentation and nonspecific symptoms. These factors often contribute to the delayed identification and management of the condition. We report a 22-year-old male construction worker from Mexico who presented with swelling and pain localized to his right hand. One week prior to presentation, he experienced minor blunt trauma to the fifth metacarpal region when a piece of wood struck his hand, with no skin breach. He denied any systemic symptoms such as fever or weight loss. Additionally, there was no history of incarceration, overcrowded living conditions, or known tuberculosis exposure. Imaging studies revealed extensive pathology in the chest and hand. Bone and soft tissue samples from the hand tested positive for acid-fast bacteria (AFB) and Mycobacterium tuberculosis (TB) by polymerase chain reaction (PCR). This case highlights an unusual presentation of tuberculous osteomyelitis involving a small hand bone in a young, immunocompetent patient. The report emphasizes the importance of comprehensive diagnostics when evaluating patients with localized swelling and no clear entry site. Tuberculosis should be considered in the differential diagnosis even without systemic symptoms.