Tenosynovitis of the Flexor Digitorum and Flexor Carpi Caused by Mycobacterium Tuberculosis: Case Report and Review

Background. Mycobacterial tenosynovitis of the hand and forearm is an extremely rare form of extrapulmonary tuberculosis, which can lead to permanent disability of patients.Case presentation. We present a rare clinical case of generalized tenosynovitis of the tendons of all hand and finger flexors of the right upper extremity caused by Mycobacterium tuberculosis. Patient complained of a lump on the palmar surface of the right hand with periodic spontaneous discharge in the form of rice grains. MRI revealed a peritendinal synovial cystic mass on the volar surface of the hand and wrist joint with the presence of multiple chondromal bodies, tendinitis and tenosynovitis of the flexor of IV and V fingers. Removal of the neoplasm, pathological tissues, and total synovectomy were performed. Intraoperative material was tested using PCR. DNA of Mycobacterium tuberculosis complex was detected.Conclusion. Presented case report demonstrates the importance of preoperative MRI examination in tenosynovitis of unknown etiology and the necessity of histological and bacteriological examination of intraoperative material. Transportation of obtained tissues for examination should be performed without the use of formalin in order to exclude false negative results. One should be vigilant against nonspecific infections, including Mycobacterium tuberculosis, when treating patients with immunocompromising diseases. The presence of limb neuropathy, instrumental signs of the second or the third stage of tuberculous tenosynovitis according to Kanavel classification are indications for surgical treatment.