The humble wrist pain could be “early” tuberculosis and a high index of suspicion may help nip it in the bud: A case report

Abstract

Osteoarticular tuberculosis of the wrist is a very rare subset of skeletal Tuberculosis. Diagnosing the tuberculosis wrist in its early stage poses a major challenge to the clinicians because of its atypical and vague presentations and a close resemblance to many relatively benign pathologies. Clinicians from developed parts of the world having less exposure to the myriad forms of osteoarticular tuberculosis are more likely to miss it. We hereby report one such case who presented with wrist pain of short duration, which after thorough examination and investigations, turned out to be tuberculous. It was successfully managed with anti-tuberculosis drugs alone without any debridement or synovectomy. Familiarity with the clinical profile of this entity, in its early stages, is valuable for primary care physicians, rheumatologists, internal medicine specialists, and orthopaedicians alike, who may confuse it with one of the many more common inflammatory, degenerative, or traumatic causes of wrist pain. Within normal range or near normal erythrocyte sedimentation rate and C-reactive protein, and normal looking X-ray does not preclude the diagnosis of tuberculosis wrist. The role of a high index of suspicion and a low threshold for getting higher radiological investigation like MRI in non-responding cases of wrist joint pain cannot be overstated.

Keywords

• osteoarticular tuberculosis
• skeletal tuberculosis
• tuberculosis wrist
• wrist pain