Tuberculosis tenosynovitis: A rare case report

A 32-year-old man was admitted to the Infectious Diseases Outpatient Clinic of Atatürk University Medical Faculty Hospital due to swelling and pain in the third finger of his left hand that had persisted for a year. The patient worked in animal husbandry and had no other complaints. Although he had already received various drug therapies, his symptoms persisted. Brucella agglutination tests showed negative results, the purified protein derivative test showed an induration of 20 × 22 mm, and the Quantiferon test showed positive results. Magnetic resonance imaging revealed tenosynovitis in the flexor muscle tendons of the second and third fingers (Figure 1A-B). A consultation was held with the orthopedic department, after which an operation was performed on the third finger of the patient’s left hand; an excision was performed, and a sample was taken¹ (Figure 2).

FIGURE 1:
(A) Wrist magnetic resonance imaging. Pre-operation non-enhanced fat suppressed T2-weighted axial and coronal (B) images show multiple hypointense rice bodies in the enlarged synovial fluid around the digital flexor tendon sheaths of the third and index fingers (arrows).

FIGURE 2:
Multiple rice bodies in the third finger, which were removed during surgery

Pathology showed necrotizing granulomatous tenosynovitis. No growth was observed in the culture for tuberculosis. Tenosynovitis due to tuberculosis was suspected. The patient was administered tuberculosis treatment consisting of isoniazid (INH), rifampicin, ethambutol, and pyrazinamide^2-3. Quadruple therapy was applied for 2 months, and INH and rifampicin were administered for 4 months. No recurrence or residual symptoms were detected at the end of treatment. No new findings were detected at the 6-month follow-up after treatment completion.

ACKNOWLEDGMENTS

We offer our deepest thanks to the Atatürk University Faculty of Medicine that provided technical support for the development and implementation of this study.

REFERENCES

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  Fatou CN, Amadou BA, Badara GA, Badara D, Mohamedi D, Bertini DC. Tuberculous Tenosynovitis of the Wrist and the Hand: The 3 Anatomo- Clinical Forms Described by Kanavel (About 4 Cases). J Orthop Case Rep. 2017;7(6):68-72. Available from: https://doi.org/10.13107/jocr.2250-0685.954
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  Jain A, Rohilla R, Devgan A, Wadhwani J. Tubercular Tenosynovitis of Hand: A Rare Presentation. J Orthop Case Rep . 2016;6(4):69-72. Available from: https://doi.org/10.13107/jocr.2250-0685.576
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  Komurcu M, Botanlioglu H, Erdem H, Albay A. Delayed and misdiagnosis of wrist tuberculosis. Int J Infect Dis. 2006;10(4):337. Available from: https://doi.org/10.1016/j.ijid.2005.04.009
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• Financial Support: No financial support was used in this study.

Publication Dates

• Publication in this collection
  08 Mar 2021
• Date of issue
  2021

History

• Received
  04 Aug 2020
• Accepted
  25 Sept 2020