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Tubercular tenosynovitis

Case contributed by Wasif Bashir
Diagnosis certain

Presentation

Painless swelling of left forearm and hand since 2 months. No history of fever.

Patient Data

Age: 60 years.
Gender: Male
ultrasound

Multifocal well marginated subcutaneous collections with thickened walls and showing multiple internal hyperechoic nodules having 'rice bodies' appearance in distal 1/3rd of left forearm contiguous with similar looking collections in the subcutaneous thenar and hypothenar areas of hand. No abnormal vascularity is seen on doppler evaluation.

Case Discussion

A 60-year-old man from a relatively low socioeconomic background presented with painless swelling in the left forearm and hand which has been progressively increasing in size. No local rise of temperature or loss of function was noted. Blood work-up showed no evidence of diabetes or rheumatoid arthritis.

The patient was referred for high resolution and color doppler ultrasonography of hand and forearm which showed multifocal subcutaneous collections in distal forearm and hand with typical 'rice bodies' within the collections, thickened tendon sheaths, and synovium. A differential diagnosis of Tubercular tenosynovitis was made on ultrasound.

USG guided fluid aspiration was done from the collections under aseptic precautions after taking informed consent and fluid was sent for TB CBNAAT which subsequently came positive for Mycobacterium Tuberculosis and confirmed the diagnosis of Tubercular tenosynovitis. The patient has since been put on the appropriate treatment regimen.

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