Department of Orthopedics, All India Institute of Medical Sciences - Rishikesh, Rishikesh, India
Department of Orthopedics, All India Institute of Medical Sciences - Rishikesh, Rishikesh, India.
BMJ Case Rep. 2021 Feb 19;14(2):e238339. doi: 10.1136/bcr-2020-238339.
Isolated multidrug-resistant (MDR) tubercular tenosynovitis of the flexor tendons of finger without involvement of wrist is a rare presentation. Tenosynovitis of hand is an uncommon manifestation of extrapulmonary tuberculosis. Pyogenic flexor tenosynovitis of hand is frequently seen and is the closest differential. Non-specific clinical signs may lead to delay in diagnosis, which is often made after biopsy. Management includes surgical excision of necrotic tissue and infected synovium along with antitubercular therapy after histopathological diagnosis. MDR tuberculosis of hand is extremely rare and, to the best of our knowledge, has not been reported in the literature so far. We report an interesting case of MDR tubercular flexor tendon tenosynovitis of the little finger without any pulmonary involvement in an immunocompetent patient. The case was managed by complete synovectomy and second-line antitubercular therapy with complete resolution of disease and had no functional limitation.
手指屈肌腱的孤立性耐药（MDR）结核腱鞘炎而不累及腕关节是一种罕见的表现。手部腱鞘炎是肺外结核的一种不常见表现。化脓性屈肌腱腱鞘炎是常见的，是最接近的鉴别诊断。非特异性的临床体征可能导致诊断延迟，通常在活检后作出诊断。治疗包括手术切除坏死组织和感染的滑膜，并在组织病理学诊断后进行抗结核治疗。手部耐多药结核极为罕见，据我们所知，目前尚未在文献中报道。我们报告了一例有趣的病例，即免疫功能正常的患者小指的 MDR 结核屈肌腱腱鞘炎，无任何肺部受累。该病例通过完全滑膜切除术和二线抗结核治疗进行管理，疾病完全缓解，且无功能受限。
