A RARE PRESENTATION OF MUSCULOSKELETAL TUBERCULOSIS: TENOSYNOVITIS OF THE FLEXOR TENDONS OF THE WRIST AND DIGITS

Abstract

One of the extrapulmonary mycobacterium tuberculosis infection is wrist tenosynovitis and treatment of the wrist tenosynovitis includes antibiotics and surgical debridement. We report the diagnosis and treatment of a patient with tuberculosis tenosynovitis of the flexor tendons of the wrist and digits. Our patient was 65 years old. In his physical examination, swelling, redness, and warming along the wrist and draining open wounds on the palmar surfaces of the first and fifth fingers at the same hand were detected. In the laboratory tests, his acute-phase reactants had increased and in the T2A series, MRI findings depicted millimetric nodular images on the sheath of the flexor tendons of the wrist and first and fifth digits, which were consistent with synovitis. Debridement and synovectomy of flexor tendons of the wrist and D1, D5 of the left side was performed. A total of 6 months of a rifampicin-based anti-tuberculosis treatment was administered. In the second year after the operation, there was no problem with previous wound, and range of motion and muscle strength of the fingers and wrist joint were complete.

Keywords

• Tuberculosis tenosynovitis
• musculoskeletal
• flexor
• wrist

MUSKULOSKELETAL TÜBERKÜLOZUN NADİR BİR FORMU: EL BİLEĞİ VE PARMAK FLEKSÖR TENOSİNOVİTİ

Abstract

Ekstrapulmoner Mycobacterium Tuberculosis enfeksiyonlarından biri el bileği fleksör tenosinovitidir. Tedavisi antibiyoterapi ve cerrahi debridmandır. Bu vaka sunumunda; el bileği ve parmak fleksör tendon tüberkülozu olan bir hastanın tanı ve tedavi süreci anlatılmaktadır. Hastamız 65 yaşındaydı, fizik muayenesinde şişlik, kızarıklık ve el bileğinde ısı artışı ile birlikte birinci ve beşinci parmakların palmar yüzlerinde drene açık yaralar mevcuttu. Laboratuvar testlerinde akut faz reaktanları yüksekti ve MRG bulguları T2A serisinde el bileği ve D1, D5 parmak fleksör tendonlarının kılıflarında sinovit ile uyumlu milimetrik nodüler görüntüler mevcuttu. Sol el bileği ve D1, D5 fleksör tendonlarının debridmanı ve sinovektomi işlemi yapıldı. Ameliyattan sonra 6 ay süre ile rifampisin bazlı anti-tüberküloz tedavi uygulandı. Ameliyat sonrası 2. yılda hastanın yara yeri problemi yoktu, el ve parmak eklem hareket açıklıkları ve kas gücü tamdı.

Keywords

• Tüberküloz tenosinovit
• muskuloskeletal
• fleksör
• el bileği

References

1. 1. Sandgren A, Hollo V, Van der Werf MJ. Extrapulmonary tuberculosis in the European Union and European economic area, 2002 to 2011. Eurosurveillance 2013;18(12):20431.
2. 2. Annabel B, Anna D, Hannah M. Global tuberculosis report 2019. Geneva: World Health Organization; 2019.p.7-9.
3. 3. Leonard MK, Blumberg HM. Musculoskeletal Tuberculosis. In: Tuberculosis and Nontuberculous Mycobacterial Infections, D. Schlossberg (Ed.). 2017.p.371-392.
4. 4. Bayram S, Erşen A, Altan M, Durmaz H. Tuberculosis tenosynovitis with multiple rice bodies of the flexor tendons in the wrist: a case report. Int J Surg Case Rep 2016;27:129- 32.
5. 5. Woon CY-L, Phoon E-S, Lee JY-L, Puhaindran ME, Peng Y-P, Teoh L-C. Rice bodies, millet seeds, and melon seeds in tuberculous tenosynovitis of the hand and wrist. Ann Plast Surg 2011;66(6):610-7.
6. 6. Kang HJ, Park SY, Shin SJ, Kang ES,Hahn SB. Tuberculous tenosynovitis presenting as carpal tunnel syndrome. J Korean Soc Surg Hand 2000;5:137-141.
7. 7. Lee SH, Abramson SB. Infections of the musculoskeletal system by M. tuberculosis. In: Rom WN, Garay SM, eds. Tuberculosis. New York, NY: Little, Brown and Company,1996. p.635-644.
8. 8. Hsu C-Y, Lu H-C, Shih TT-F. Tuberculous infection of the wrist: MRI features. Am J Roentgenol 2004;183(3):623-8.

9. 9. Sawlani V, Chandra T, Mishra RN, Aggarwal A, Jain UK, Gujral RB. MRI features of tuberculosis of peripheral joints. Clin Radiol 2003;58(10):755-62.
10. 10. Kanavel AB. Tuberculous tenosynovitis of the hand: a report of fourteen cases of tuberculous tenosynovitis. Surg Gynecol Obstet 1923;37:635-47.
11. 11. Benchakroun M, Bardouni A El, Zaddoug O, Kharmaz M, Yaacoubi M El, Ouadghiri M, et al. Tuberculosis of the wrist. Symptoms and outcome in eleven cases. Rev Chir Orthop Reparatrice Appar Mot 2004;90(4):337-45.