Parona space tuberculosis and S. aureus superinfection, a rare and potentially misleading clinical entity

In the last few years, tuberculosis (TB) infections resurfaced in Europe. Despite its growing incidence, muscoloskeletric localization and in particular hand involvement represents a rare presentation of TB, representing only 1-2% of cases. We report the case of a 64-year-old man, presenting to our department with hand swelling and fever. The unclear radiological findings demanded a surgical exploration that revealed the presence of caseous necrotic material. Cultural samples confirmed Koch bacillus presence over infected by a Staphylococcus aureus. No other systemic signs of tuberculosis were found. TB hand infections are clinical entities difficult to recognize and to diagnose, especially in absence of systemic symptoms. TB must be suspected whenever compatible clinical and intraoperative findings are recognized, to avoid severe chronic morbidities or dissemination of the disease.