Tenosynovitis Tuberculosis of the Clean Sheath of the 5th Finger of the Hand: A Rare Localization
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 5, Issue 3
Abstract
Tenosynovitis tuberculosis of the hand is a rare form of extra-pulmonary localization. we report an observation of localization of tuberculosis at the level of the clean sheath of the 5th finger of the hand.We emphasize the importance of the biopsy followed by an anatomopathological examination which remains the basis of the diagnosis.An early diagnosis allows a well-defined medical treatment presenting complications. Introduction Although rare in developed countries, tuberculosis is one of the most feared diseases in underdeveloped and developing countries, where it is a real public health problem. Its unusual localizations such as tuberculoustenosynovitis are often unknown and are accompanied by a delay in diagnosis and therapy, especially since formal histological evidence may sometimes be absent. We report an observation of tuberculous tenosynovitis of the sheath of the fifth finger of the hand. Clinical Case 33-year-old female right-handed student whom we received in consultation for a swelling of the left hand and wrist.Swelling evolving for 3 years without any notion of trauma (Figure 1). In addition, the patient presents a notion of tuberculous contusion because having lived with a tuberculous patient under treatment for 4 months.The clinical examination found the presence of BCG vaccination scar at the level of his right arm, a renal swelling at the palmar surface of the left hand following the synovial sheath proper of the flexor fingers of the 5th finger up to the level of the wrist. In recent days our patient has a syndrome of deterioration of the general state associating an asthenia, anorexia and a slimming associated with a vespero nocturnal fever.In her body the biological examination was normal as well as the X-ray of the hand and the thorax as well as the bacilloscopy. Tuberculin intradermal reaction was positive at 15mm. The MRI showed an effusion of the synovial sheath of the flexor tendons of the 5th finger of the hand with intense enhancement of solid and homogeneous in the carpal tunnel (Figures 2 & 3). A biopsy was performed and at macroscopy we found inflammation of the synovium of the clean sheath of the fifth finger. The search for AFB in the puncture fluid of the synovial sheath is negative. Histopathological examination revealed Langhans-type epithelioid and giant cell granulomatous inflammatory lesions with some giant cells associated with a lympho-plasmocytic infiltrate without necrosis but strongly suggestive of tuberculosis.In front of this table the diagnosis of a synovial tuberculosis of the clean sheath of the 5th finger is retained. Quadruple antituberculous therapy was prescribed for two months and then dual therapy for four months.
Authors and Affiliations
Dembélé Badara, Gueye Alioune Badara, Diouf Alioune Badara, Dia Rokhaya, Nguessi Idriss, Sarr Lamine, Daffé Mouhamed, Coulibaly Ndéye Fatou, Sané André Daniel, Diémé Charles Bertin
Keywords
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- EP ID EP591687
- DOI 10.26717/BJSTR.2018.05.001193
- Views 154
- Downloads 0
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