Tuberculosis of the wrist mimicking rheumatoid arthritis - A rare case

INTRODUCTION: Mycobacterium tuberculosis causes infection in approximately one-third of the world's population. Arthritis due to Mycobacteriurn tuberculosis usually presents as a chronic, slowly progressive, monoarticular infection that predominantly involves the weight-bearing joints and the spine. The hand and wrist are rare sites for tuberculosis (TB) and comprises of < 1% of all skeletal TB. Even though it is rare, TB of the wrist is a cause of great morbidity. We presented a case of wrist TB treated with debridement and synovectomy. PRESENTATION OF CASE: A 35 years old woman came with the chief complaint of pain and swelling on the right wrist since 1 year ago and was diagnosed with rheumatoid arthritis of the wrist. Patient then was given methylprednisolone 4 mg twice a day and methotrexate 175 mg once a week. However, the pain and swelling of her right wrist became worse. Subsequently patient was admitted to hospital and laboratory findings suggested a tuberculous arthritis of the wrist. Debridement, synovectomy, and biopsy, in addition to antituberculosis therapy, were then performed. DISCUSSION: Tuberculous arthritis is generally a monoarticular disease that typically involves the spine or large and medium-sized joints. Rheumatoid arthritis (RA) and tuberculous arthritis may have similar clinical characteristics, which consists of a chronic course with periarticular soft-tissue swelling. CONCLUSION: Tuberculous arthritis and RA can have similar characteristic but laboratory examination can help in establishing diagnosis. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.