Chronic tenosynovitis of the hand – an unusual presentation of tuberculosis in children
Keywords:chronic hand pain, tenosynovitis, tuberculosis
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.
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