Tuberculous tenosynovitis of hand and wrist is a rare disease but it is found sometimes, especially in TB-endemic areas. The clinical presentation is not specific, however, most patients present with painless swelling at the wrist and hand with limited range of motion, and nerve compression symptoms have been reported. The diagnosis of this conditions can be made from histopathology. Antituberculosis drugs are the mainstay treatment while surgery is controversial.Case presentationWe present the case of an 83-year-old Thai woman with no history of exposure to tuberculosis. She presented with swelling and mild pain at her right wrist and the fifth finger of her right hand for 3 months. Ultrasonography revealed tenosynovitis in the right hand and wrist.Mycobacterium tuberculosiswas confirmed with tissue diagnosis after an open biopsy. 2-months regimens containing Isoniazid, Rifampicin, Pyrazinamide and Ethambutol/6-months of isoniazid and rifampicin treatment was successful without complications. We follower her up for 1 year, at which time she had returned to do normal daily activities. Her final DASH score was 10.8.ConclusionTuberculous tenosynovitis is rare, but still occasionally encountered, especially in TB-endemic areas. The challenge is that this condition is difficult to diagnose due to its clinically insidious onset and the presentation is not obviously specific. Laboratory analysis, imaging (MRI, ultrasonography) and microbiology are useful to help reach a diagnosis, but finally confirmation is from histopathology. The treatment mainstay is medical, but surgery may be required if conservative treatment fails or in late stages of the disease.
展开▼
