TUBERCULOUS TENOSYNOVITIS PRESENTING ITSELF AS CARPAL TUNNEL SYNDROME AND WRIST GANGLION

Öz

Tuberculosis caused by Mycobacterium tuberculosis is a well known and one of the oldest infectious diseases to affect humans. There is a recent increase of its incidence due to development of resistance to antituberculosis drugs and conditions associated with immunodeficiency such as AIDS and chemotherapy. As a result, unusual presentations of tuberculosis have been encountered more frequently in the last decade. Although soft tissue tuberculosis is a well recognized form of extrapulmonary tuberculosis, primary tuberculous tenosynovitis is rare. We report an immunocompetent male patient with a very rare presentation of extrapulmonary tuberculosis, tuberculous tenosynovitis of the wrist, presenting itself as carpal tunnel syndrome and wrist ganglion.

Anahtar Kelimeler

• Tuberculous tenosynovitis
• carpal tunnel syndrome
• wrist ganglion
• treatment.

KARPAL TÜNEL SENDROMU ve BİLEKTE GANGLİON ŞEKLİNDE GÖZÜKEN TÜBERKÜLOZ TENOSİNOVİTİ: Olgu sunumu

Öz

Mikobakteryum tüberkülozis tarafından oluşturulan tüberküloz insanoğlunu etkileyen, iyi bilinen en eski enfeksiyon hastalıklarından biridir. Antitüberkülo ilaçlara karşı gelişen direnç ve AİDS- kemoterapi gibi nedenlerle oluşan immün yetmezlik tüberküloz insidensinde artışa yol açmıştır. Bu nedenlerle son yıllarda alışılmışın dışında tüberküloz tablolarıyla karşılaşılmaktadır. Yumuşak doku tüberkülozu ekstrapulmoner tüberkülozun çok tanınan şekli olmasına rağmen primer tüberküloz tenosinoviti nadir görülür. Bu çalışmada, ekstrapulmoner tüberkülozun nadir görülen formlarından tüberküloz sinovitin kendisini klinik olarak karpal tunnel sendromu ve bilekte ganglion olarak gösterdiği olgu sunulmaktadır.

Anahtar Kelimeler

• Tüberküloz tenosinovit
• karpal tunnel sendromu
• bilek ganglionu
• tedavi.

Kaynakça

1. Cramer K, Seiler JG, Milek MA. Tuberculous tenosynovitis of the wrist: two case reports. Clin Orthop Relat Res 1991;262:137–140.
2. Jaovisidha S, Chen C, Ryu KN, Siriwongpairat P, Pekanan P, Sartoris DJ, Resnick D. Tuberculous tenosynovitis and bursitis: imaging findings in 21 cases. Radioiogy 1996; 201:507-13.
3. Kotwal PP, Khan SA. Tuberculosis of the hand: clinical presentation and functional outcome in 32 patients. J Bone Joint Surgery Br. 2009; 91B, 105410
4. Patel MR, Malaviya GN, Sugar AM. Chronic infections. In: Greens operative hand surgery. Eds: Green DP, Hotchkiss RN, Pederson WC, Wolfe SW. 5 th ed. Philadelphia: Elsevier-Churchill Livingstone 2005: 94-158.
5. Ruhwald M, Aabye MG, Ravn P: IP-10 release assays in the diagnosis of tuberculosis infection: current status and future directions. Expert Rev Mol Diagn 2012; 12:175-87.
6. Sanders CJ, Schucany WG. Tuberculous tenosynovitis. Proc (Bayl Univ Med Cent). 2008; 21: 71–
7. Suso S, Peidro L, Ramon R. Tuberculous synovitis with “rice bodies” presenting as carpal tunnel syndrome. J Hand Surg Am 1988;13A:574–576.
8. Tappeiner G, Wolff K. Tuberculosis and other mycobacterial infections. In: Dermatology in General Medicine. Eds: Fitzpatrick TB, Freedberg IM, Eisen AZ, Wolff K. 4 th ed. New York: McGraw-Hill Company, 1999: 2274-92.

9. Woon CY, Phoon ES, Lee JY, Puhaindran ME, Peng YP, Teoh LC. Rice bodies, millet seeds, and melon seeds in tuberculous tenosynovitis of the hand and wrist. Ann Plast Surg. 2011 Jun;66(6):610-7.