Chronic tenosynovitis of the hand – an unusual presentation of tuberculosis in children
DOI:
https://doi.org/10.25753/BirthGrowthMJ.v30.i3.20302Keywords:
chronic hand pain, tenosynovitis, tuberculosisAbstract
Tuberculosis remains the most common cause of death from infectious diseases worldwide. Extrapulmonary tuberculosis with musculoskeletal involvement occurs in about 10-15% of cases, mainly affecting joints and bones. Of these, only 1-5% are reported as synovitis of the hand. However, prompt diagnosis and treatment are often delayed and, if left untreated, bone and tendon destruction soon ensue and may lead to chronic synovitis.
A 15-year-old girl presented with recurrent pain of the hand following trauma. Imaging showed tenosynovitis and tendon rupture. Surgical treatment was performed. Pathological assessment revealed necrotic caseous granulomas. Chest radiography showed no abnormal findings, but both Tuberculin Skin Test and Interferon Gamma-Release Assay were positive. Tuberculous tenosynovitis was diagnosed, and 12-month anti-tuberculous chemotherapy was instated. Five years after surgery, the patient maintained chronic pain and functional hand limitation.
Tuberculous tenosynovitis of the hand is a rare and insidious condition that should be considered in the differential diagnosis of chronic hand pain. Delayed diagnosis and treatment can lead to residual functional limitation, making disease recognition critical.
Downloads
References
World Health Organization. Global Tuberculosis report 2019 [Internet]. Geneva; 2019. Available from: https://www.who.int/tb/global-report-2019.
Weber E, Gagneux-Brunon A, Jacomo V, Rousselon T, Lucht F, Botelho-Nevers E. Tenosynovitis: a rare presentation of tuberculosis better known by hand surgeons than infectious diseases specialists. Infection. 2015;43(3):261–6.
Jain A, Rohilla R, Devgan A, Wadhwani J. Tubercular Tenosynovitis of Hand: A Rare Presentation. J Orthop case reports. 2016;6(4):69–72.
Sbai MA, Benzarti S, Boussen M, Maalla R. Tuberculous flexor tenosynovitis of the hand. Int J Mycobacteriology. 2015;4(4):347–9.
Hogan JI, Hurtado RM, Nelson SB. Mycobacterial Musculoskeletal Infections. Infect Dis Clin North Am [Internet]. 2017;31(2):369–82. Available from: http://dx.doi.org/10.1016/j.idc.2017.01.007
Baidoo PK, Baddoo D, Ocloo A, Agbley D, Lartey S, Baddoo NA. Tuberculous tenosynovitis of the flexor tendons of the wrist: A case report. BMC Res Notes [Internet]. 2018;11(1):4–8. Available from: https://doi.org/10.1186/s13104-018-3343-4.
Arora S, Sethi S. Isolated Tubercular Tenosynovitis in Children: Report of seven cases. J Pediatr Orthop. 1994;14:752–4.
Velayati AA, Farnia P, Mozafari M, Malekshahian D, Farahbod AM, Seif S, et al. Identification and genotyping of Mycobacterium tuberculosis isolated from water and soil samples of a metropolitan city. Chest. 2015, Apr;147(4):1094-102.
Kanavel AB. Tuberculous tenosynovitis of the hand. Surg Gynecol Obs. 1923;37:635.
Bush DC, Schneider LH. Tuberculosis of the hand and wrist. J Hand Surg Am. 1984, May; 9(3):391-8.
Turecki MB, Taljanovic MS, Stubbs AY, Graham AR, Holden DA, Hunter TB, et al. Imaging of musculoskeletal soft tissue
infections. Skeletal Radiology. 2010. Oct; 39(10):957-71.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Miguel Vieira Martins, Constança Santos, Ana Luísa Teixeira, Ricardo Costa, Jorge Pon, Carlos Rodrigues
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and access
This journal offers immediate free access to its content, following the principle that providing free scientific knowledge to the public provides greater global democratization of knowledge.
The works are licensed under a Creative Commons Attribution Non-commercial 4.0 International license.
Nascer e Crescer – Birth and Growth Medical Journal do not charge any submission or processing fee to the articles submitted.