Disseminated tuberculosis to wrist and testes

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Presents with right wrist pain, swelling and deformity. Complains of pain and swollen right testicle. Dry cough. Exposure to TB in the Army 30 years ago in the dormitory.

Patient Data

Age: 55 years
Gender: Male
  • multiple lytic lucencies in all the carpal bones, base of metacarpals, and distal radius
  • juxta articular osteopenia
  • no osteophytes
  • no joint narrowing

Typically, the metaphyses are involved,

Osteopenia and poorly defined lytic lesions

minimal surrounding sclerosis.

Tree in bud opacities suggesting transbronchial spread of tubeculosis. Suggesting very active TB.

Infiltrative process in the right testicle. This testicle was normal on ultrasound 6 months prior.

Case Discussion

The work up for sexually transmitted diseases were negative.  His sputum culture was positive for Mycobacterium tuberculosis. He was discharged home on ethambutol, rifampin, pyrazinamide and pyridoxine.

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