Tuberculous tenosynovitis of the flexor tendons of the wrist: A case Report.

Introduction Tuberculous tenosynovitis of the flexor tendons of the wrist also referred to, as a compound palmar ganglion is uncommon. It has a classical clinical presentation and histopathology confirms it. Case Presentation We present a case of a 65 year old Ghanaian female with a two-year history of a progressively enlarging dumbbell shaped mass over the volar surface of the right wrist and palm. She did not have a previous history of tuberculosis. However, her Erythrocyte Sedimentation Rate (ESR) was high and Mantoux test was strongly positive (more than 15mm). Radiograph of ulna, radius and wrist showed osteopenic changes of the distal radius. Findings at excision biopsy were inflamed, thickened synovia and rice bodies. Tissue samples were submitted for histological and microbial studies. Anti-tuberculous therapy was commenced on the second postoperative day. Conclusion Tuberculous tenosynovitis of the wrist is uncommon. However in developing countries like Ghana where tuberculosis is prevalent, it should be part of the differential diagnosis of compound palmar ganglion in order to prevent delayed diagnosis and treatment.

引言 腕部屈肌腱结核性腱鞘炎，又被称为复合掌腱鞘囊肿（compound palmar ganglion），临床较为罕见。该疾病具有典型的临床表现，可通过组织病理学检查确诊。
病例报告 本文报道1例65岁加纳女性患者，其右侧腕部及掌侧掌面出现渐进性增大的哑铃状肿块，病程长达2年。患者既往无结核病史，但红细胞沉降率（Erythrocyte Sedimentation Rate, ESR）检测结果升高，结核菌素皮肤试验（Mantoux test）呈强阳性（硬结直径＞15mm）。尺骨、桡骨及腕部X线片显示桡骨远端存在骨质稀疏改变。切除活检结果提示滑膜组织充血增厚，伴米氏小体（rice bodies）。送检组织样本用于组织学及微生物学检测。术后第2天即启动抗结核治疗。
结论 腕部屈肌腱结核性腱鞘炎较为罕见，但在加纳这类结核流行的发展中国家，临床医师应将其纳入复合掌腱鞘囊肿的鉴别诊断范畴，以避免延误诊断与治疗。