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THU0247 Flexor Tuberculous Tenosynovitis of the Hand: About 8 Cases
  1. S. Miladi,
  2. D. Kaffel,
  3. R. Dhahri,
  4. I. Cherif,
  5. W. Hamdi,
  6. I. Zouch,
  7. M.M. Kchir
  1. Rheumatology, Institut Kassab, Manouba, Tunisia

Abstract

Background Tuberculous infection of the musculoskeletal system count 10% of all extrapulmonary cases of tuberculosis (TB). In musculoskeletal tuberculous infections, the involvement of TB in peripheral joints and tendons is rare. In this report we will describe 8 cases of flexor tuberculous tenosynovitis (FTT).

Objectives The aim of our work is to analyze the diagnostical, therapeutical and evolutionary aspects of this disease through a series of 8 cases of FTT patients treated.

Methods A retrospective study was conducted selecting patients followed-up for FTT. Patients hospitalized during the period from 2008 till December 2014 were recruited. Previous history of TB or exposure to TB was searched. All patients underwent hands plain radiographies and ultrasounds, chests radiographies, tuberculin skin test (TST), sputum smears and cultures; then to surgical synovectomy with histological and bacterial examination.

Results Eight patients were included (5 females, 3 males), with a mean age of 45 years-old [33 – 59]. All patients were immunocompetent and without a past medical history of TB. A local steroid injection preceding the infectious episode was noted in one case and a cow bite was revealed in another case. The mean period before consulting was 15 months [3-23]. Fever, night sweats and weight loss was noted in 3 patients. First symptom of illness was swelling of the palmar side in 4 cases, of the left 4th finger in 2 cases, of the right 5th finger in one case and a carpal tunnel syndrome in an another case. Hands plain radiographies weren't contributive for the diagnosis, however ultrasound showed flexor tenosynovitis in all cases. Chest radiography revealed squeal of tuberculosis in one patient. TST was always positive but sputum smears and cultures were negatives in all cases. Histological examinations and bacterial culture confirm the diagnosis of FTT in all patients. Combination of anti-tuberculosis antibiotics was well conducted and evolution was good for all patients.

Conclusions Although rarely seen, FTT should be kept in mind if we found chronic flexor tenosynovitis; a detailed medical history and careful clinical examination should be taken to prevent misdiagnosis. Histological examinations and bacterial culture are very important to confirm the diagnosis.

Disclosure of Interest None declared

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