Flexor Tenosynovitis of the Hand Caused by Mycobacterium tuberculosis

Abstract

Infectious tenosynovitis of the hand is a serious condition with a high risk of morbidity. Mycobacterium tuberculosis is a rare cause of tenosynovitis, especially in regions where tuberculosis is no longer endemic, and presents significant diagnostic challenges. We present the case of a 42-year-old woman with no known history of or exposure to tuberculosis and a medical history of systemic lupus erythematosus on chronic immunosuppressive therapy who presented with swelling and erythema in the fifth finger of the left hand of 1-month duration. She underwent tenosynovectomy, and intraoperative cultures grew M tuberculosis. The patient completed an appropriate antibiotic regimen, and systemic workup revealed ring-enhancing lesions on brain MRI consistent with tuberculoma. We review the literature and current trends in the management of mycobacterial tenosynovitis, as well as the important teaching points of the case.

Tuberculosis, a Rare Cause of Hands Tenosynovitis: Two Case Reports

“…The gold standard method in the de nitive diagnosis of tuberculous tenosynovitis is the histopathological examination of the synovectomy material. Microscopic examination reveals caseous granuloma, epithelioid histiocytes, and giant cells [10]. In our cases, there was no growth in cultures and AFB (-).…”

A Case Report of Tuberculosis in the Finger

“…It has been identified in only a small number of cases in adults [6][7][8]. There have been, however, more reports of TB tenosynovitis or dactylitis in the hands, with swellings and pain, rather than cutaneous lesions [9][10][11][12][13][14][15][16].…”

Tuberculous tenosynovitis of the hand: A challenging diagnosis

“…1 In developing countries, like ours, tuberculous should be considered among causes of chronic tenosynovitis. 1,2 The diagnosis of tuberculous tenosynovitis of the hand could be suspected by clinical and radiological findings and confirmed by bacterial and histological findings. An appropriate and fast diagnosis of tuberculous tenosynovitis is crucial to avoid inappropriate treatment.…”

“… 1 In developing countries, like ours, tuberculous should be considered among causes of chronic tenosynovitis. 1 , 2 …”