Tuberculous extensor tenosynovitis of the hand

Abstract

Tuberculous tenosynovitis is a rare manifestation of extrapulmonary tuberculosis (Tb), especially if solely the dorsal hand compartment is affected. In this report, we present the medical history of an immuno-competent 32-year-old man presented with a painful swelling of the right dorsal wrist. Initial inflammation onset had occurred 6 months before he consulted our service, resulting in consultation of several physicians and extensive diagnostic procedures without gaining a specific diagnosis. Finally, after extensive diagnostic tests, a tenosynovectomy was performed and tuberculosis-induced extensor tenosynovitis was detected. The diagnosis was established by positive histology, repeated specific PCR and T-SPOT.TB. Tuberculous tenosynovitis can easily be overlooked as a cause of chronic tenosynovitis particularly in immunocompetent young people lacking any risk factors.

Atraumatic Pyogenic Extensor Tenosynovitis of the Extensor Digitorum Longus

“…In those rare cases without evidence of IV drug use, pyogenic extensor tenosynovitis has occurred secondary to rare fungus or atypical bacteria [ 3 , 4 ]. Mason et al describe the case of a 48-year-old male with unicentric Castleman’s disease who presented with an 8-month history of progressively enlarging mass on the dorsum of his left hand [ 4 ].…”

“…He was found to have cryptococcal extensor tenosynovitis and was successfully managed with surgical debridement and antifungal therapy. Probst et al describe another case of a 32-year-old immune-competent male who presented with chronic tuberculous-induced extensor tenosynovitis of his wrist [ 3 ]. He was treated with surgical tenosynovectomy and multidrug tuberculosis therapy.…”

“…Pyogenic tenosynovitis occurs almost exclusively in the flexor tendons of distal extremities, more commonly in the hand/wrist than the ankle/foot [ 1 , 2 ]. Most commonly documented in the literature of extensor pyogenic tenosynovitis are case reports in the upper extremities caused by atypical bacteria or fungi [ 3 , 4 ], with only two cases caused by Staphylococcus aureus [ 5 , 6 ]. In a case series of 20 patients with documented extensor pyogenic tenosynovitis, only five out of the 20 cases were in the foot/ankle region, and all of which were intravenous (IV) drug users [ 7 ].…”

A Rare Case of Flexor Tenosynovitis Due to Tuberculosis in Hand and Wrist: a Case Report

“…The flexor tendons are the most common site of hand and wrist tuberculous tenosynovitis. Extensor tendon involvement is uncommon (11). In the disease that has been going on for a long time, necrotic joint synovium and accumulation fibrinous material in the synovial fluid may lead to producing rice bodies (9).…”

Flexor Tenosynovitis of the Hand Caused by Mycobacterium tuberculosis

“… 4 Extensor tendon involvement is uncommon, as one series found that only 2 of 32 patients had both extensor and flexor involvement, and there are very few reports of isolated extensor sheath infection. 3 , 9 …”