Multi focal tuberculosis

A 19-year-old salesman presented with multiple fusiform, fluctuant, non-tender swellings involving dorsum of the left hand, left index finger and little finger. He also had multiple sinuses with puckered scars on the right thumb, left little finger and right elbow. He was provisionally diagnosed as tuberculous gumma. X-ray chest showed apical cavity and infiltration suggestive of tuberculosis X-ray both hands showed osteolytic lesions with pathological fracture. AFB was cultured on Lowenstein Jensen medium and the patient was given antituberculosis treatment with clinical improvement.