A rare presentation of late diagnosis of tuberculosis tenosynovitis of flexor tendons of the hand: Case report

Abstract

Background: Tuberculosis tenosynovitis of the wrist and hand is a rare illness. It imitates several different clinical illnesses, including ganglion, De Quervan's disease, carpal tunnel syndrome, granulomatous gout, neurofibroma, and haemangioma. Case report: We present case of a 27-year-old female patient with three years of right hand pain, swelling, and limited finger movement. The patient had no relevant personal history or previous infectious diseases, such as tuberculosis. Hand examinations revealed inflammation in the affected fingers, and ultrasound showed synovial hypertrophy. Surgery was performed to release the first finger's A1 pulley and perform tenosynovectomy on the affected flexor tendons. Despite anti-inflammatory medication, physical therapy, and two finger infiltrations, the patient's tenosynovitis of the third finger persisted. Histology revealed caseating granulomatous transformation, and a positive Ziehl Neelsen stain confirmed the diagnosis of tuberculosis tenosynovitis. The patient underwent anti TB treatment and experienced delayed wound healing. The case is unique as functional limitations were observed in the postoperative period, specifically in the range of motion of the third finger's proximal interpharyngeal joint. Conclusion: Late diagnosis of tuberculosis tenosynovitis can lead to functional impairments even after appropriate therapy. The study highlights the importance of considering the disease as a differential diagnosis and emphasizes the need for prompt treatment to prevent recurrence or a permanent functional disability.

Keywords

• Tuberculosis
• Tenosynovitis
• Tenosynovectomy
• Synovial hypertrophy
• Flexor tendons