Tuberculous Tenosynovitis Presenting as Ganglion of Wrist

Abstract

Tuberculosis (TB) is still endemic in many developed countries. Involvement of the hand and wrist at presentation is extremely rare, and the diagnosis is often missed. A 57 years old male presented with swelling over the left wrist since 3 years Three swellings over dorsal aspect of the left wrist Soft in consistency Non tender Non compressible Mobile at right angles to the plane of the wrist joint. ESR: 45 mm in 1 hr and rest blood investigations were normal. Ultrsonography showed giant cell tumor of Extensor Digitorum sheath. X-ray: soft tissue swelling and MRI was suggestive of extensor tendon sheath extraskeletal synovial Koch's, or giant cell tumor of tendon sheath. Excision of swelling was planned and intraoperatively, rice bodies were seen inside it. Histopathological examination showed caseous necrosis with granuloma formation. Patient was put on DOT1 therapy. Tuberculous tenosynovitis was first described by Acrel in 1777. Rice bodies occurring in joints affected by tuberculosis were first described in 1895 by Reise. Rice bodies will be diagnosed on plain radiographs when mineralization occurs. More than 50% of cases recur within 1 year of treatment. The currently recommended 6-month course is often adequate with extensive curettage lavage and synovectomy should be performed. Surgery is essential, but the extent of surgical debridement is still debatable. The surgeon has to be aware of the significance of loose bodies when performing routine excision of innocuous looking wrist ganglia.

Hand and wrist tuberculosis in paediatric patients – our experience in 44 patients

“…Differential diagnoses include rheumatoid and other seronegative inflammatory arthritis, benign and malignant neoplastic conditions, Keinbock's disease and metabolic conditions such as haemophilia and gout. It is not uncommon to find case reports where TB mimics mass lesion, fracture or ganglion [16][17][18]. Tumours commonly mimic a spina ventosalike picture [19].…”

Ancient foe spectra: Case series of Mycobacterium tuberculosis presentations

“…The third case highlights one of the ramifications of musculoskeletal TB. Although tuberculosis of the hand is seen in 10% of musculoskeletal TB, ganglion‐like TB of the wrist and hand is rare with few reported cases in the literature 13‐16 . The clinical picture as our case is indistinguishable from other similar pathology and only confirmed upon histopathological examination 13 .…”

Rice Bodies Accompanied by Tenosynovitis of the Wrist: A Case Report and Literature Review

“…In terms of clinical presentation, our case was quite similar to cases observed in the literature, highlighted by a mass that enlarges progressively with time. The presentation is acute (less than six months) [ 1 , 3 , 7 ] in some cases and chronic in others (more than six months) [ 6 , 9 - 12 ], and thus, some patients present with painful masses, while others present with painless masses. There is no trend in regard to laterality, as some cases present with masses in the right or left wrist [ 1 , 5 , 11 - 13 ].…”