Delayed and misdiagnosis of wrist tuberculosis. of the International Society for Infectious Diseases

摘要

Of all episodes of skeletal tuberculosis, 2% involve the hand and foot. Although the diagnosis of extrapulmonary tuberculosis is confirmed by the pathological examination of biopsy material and positive culture, it is well known that the frequent absence of laboratory assistance complicates the diagnosis of the disease.A 21-year-old male patient presented to the Department of Orthopedics, Gulhane Medical Academy with complaints of pain, impaired mobility and progressive swelling of the right wrist. The patient, who did not disclose a history of tuberculosis, was followed up in the Department of Rheumatology for six months. The diagnosis was considered to be inflammatory arthritis and the patient was given nonsteroidal anti-inflammatory drugs during this period. The patient was then sent to our department by the rheumatologist due to enlargement of the lesion. On physical examination, there was a mass at the extensor area of the right wrist. Hyperemia was seen over the mass, which was soft on presentation. Movements of the wrist were limited and painful.Erythrocyte sedimentation rate was 5 mm/h, white blood cell count was 5.6 x 10~9/l and the C-reactive protein was 29 mg/dl. No active pathology was detected on chest X-ray. Although no pathological finding was noted for the carpal bones in the initial X-rays obtained six months earlier, the more recent images showed marked destruction of the area. The images from magnetic resonance imaging were interpreted as extensive inflammatory activity in the radiocarpal, intercarpal as carpo-metacarpal areas and at the periphery of the extensor tendons.