Tuberculous tenosynovitis

Case contributed by Dr Yasser Asiri

Presentation

Right wrist mass.

Patient Data

Age: 35 years
Gender: Female
MRI

Marked synovial thickening is seen in the fourth and fifth extensor compartments with a large amount of fluid and multiple bodies within the tendon sheaths. The bodies are uniform in shape and show moderately high T2 and isointense T1 signal intensity. Enhancement of the thickened synovium is noted in the post-contrast images. 

No erosive changes could be seen. A small split tear of the extensor carpi ulnaris tendon is noted. The rest of the extensor tendons are unremarkable. The TFCC, intrinsic and extrinsic ligaments around the wrist are grossly unremarkable. The flexor tendons, ulnar and median nerves are unremarkable. 

Case Discussion

Classic appearance of rice bodies is demonstrated in this case. Rice bodies are seen in the setting of chronic synovial inflammation like rheumatoid arthritis or TB infection. The patient was initially investigated for soft tissue masses over the dorsal aspect of the wrist. MRI study showed isolated tenosynovitis of the fourth and fifth extensor compartments with synovial thickening and rice bodies. The lack of other rheumatoid features would make the possibility of TB tenosynovitis more likely.

The patient subsequently underwent synovectomy, histology and microbiology results came back positive of mycobacterium tuberculosis. The patient was initiated on anti-TB medications.

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Case information

rID: 77514
Published: 15th May 2020
Last edited: 17th May 2020
Inclusion in quiz mode: Included

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