Tuberculous tenosynovitis involving wrist and extensor compartment of the forearm: Case presentation

Abstract

Musculoskeletal tuberculosis is a rare form of extrapulmonary tuberculosis, constituting <10% of cases even in developing countries. Diagnosis and treatment are usually delayed due to non-specific findings. In this case report, we presented a 55-year-old male butcher who had complaints of pain and tenosynovitis at the dorsal side of the right wrist after trauma, for which we performed surgery upon diagnosis of ganglion cyst secondary to steroid injection. The patient had developed a second lesion on the forearm of the same extremity while waiting for the initial report of the biopsy specimen, which showed positive Ziehl-Neelsen staining, necrotizing granulomatous inflammation, caseating necrosis. No growth was detected in the culture. The patient received anti-tuberculosis treatment for 12 months and no recurrence was observed at a 1-year follow-up. Since tuberculous tenosynovitis can be confused with other diseases, the diagnosis may be established late. Contraindicated procedures such as corticosteroid injection can be applied to the patient due to inaccurate pre-diagnosis, which may activate the disease. It may be important to suspect this disease considering the risk factors and occupational group. Performing ultrasonography and biopsy with a pre-diagnosis of tuberculosis can be a guide for early diagnosis and treatment.

Key words: Extensor compartment, forearm, tuberculous, tenosynovitis, wrist