Unusual and memorable

Case Number 23: Tuberculous tenosynovitis

U A Walker, J Gutfleisch, H H Peter

Series editor: Gary D Wright

Albert-Ludwigs University Medical School, Department of Rheumatology and Clinical Immunology, Freiburg, Germany

Correspondence to:
Correspondence to:
Dr U A Walker, Albert-Ludwigs University Medical School, Department of Rheumatology and Clinical Immunology, Hugstetterstr 55, D-79106 Freiburg, Germany;
walkerul@uni-freiburg.de

Accepted 11 Dec 2001

Keywords: tuberculosis; tenosynovitis; human; hand; wrist

A 58 year old woman presented with a several month history of painful swelling of the second and fifth fingers of her left hand (fig 1). The flexor tendon sheath of the index finger had been excised six months before. Median nerve entrapment led to surgical release of the transverse carpal ligament three months ago. In both instances histopathological examination disclosed necrotising granulomas with Langerhans'cells. The swelling progressed to affect the subcutis of the forearm and the fascia of the superficial and deep flexor muscles. Diagnosis was delayed until there was spontaneous perforation of the index finger and Mycobacterium tuberculosis was cultured. The patient had had pulmonary tuberculosis at the age of 16 years, but there were no other signs of current reactivation. She improved rapidly with tuberculostatic treatment.

View larger version (70K): [in this window] [in a new window]   Figure 1

 

Even before the era of effective antituberculous chemotherapy, tuberculous tenosynovitis was a rare condition. Nevertheless, tuberculosis was reported to be . . . [Full text of this article]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?