Abstract
Objective: This case report presents a rare case of recurrent multifocal musculoskeletal tuberculosis (TB) of the wrists, mimicking rheumatoid arthritis, and highlights the diagnostic challenges in osteoarticular TB. Case Report: A 41-year-old female initially presented in 2014 with right wrist swelling. Magnetic resonance imaging (MRI) findings suggested tuberculous tenosynovitis, and she was treated with a nine-month course of antituberculous therapy (ATT), leading to symptom resolution. Nearly a decade later, the patient developed bilateral wrist swelling. Radiological imaging revealed erosions and collections suggestive of TB. An initial synovial biopsy yielded inconclusive results, initially suggesting rheumatoid arthritis (RA); however, further workup for RA was negative. Notably, after several days, cultures from the synovial biopsy confirmed Mycobacterium tuberculosis sensitive to rifampicin and isoniazid. A second course of ATT was initiated, resulting in complete symptom resolution. Conclusion: This case underscores the diagnostic complexity of musculoskeletal TB, particularly when it mimics autoimmune conditions like RA. The initial misleading biopsy results highlight the importance of thorough, repeated investigations in chronic musculoskeletal complaints in TB-endemic regions. Prompt recognition and treatment of TB in such atypical presentations are crucial for preventing morbidity and preserving joint function.
Published Version
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