Pathologic resorption of the scaphoid: A rare presentation of TB wrist

Abstract

A 79 year old gentleman, presented to our clinic, complaining of pain and swelling on the right wrist, for two months, complaints being insidious in onset, and progressive for two months. He was evaluated clinically and radiologically, and an x-ray showed features suggestive of atrophic resorbtion of the right scaphoid. A biopsy of the right wrist yielded fibro-collagenous tissue, with epitheloid granulomas, langhans type of giant cells, and surrounding chronic inflammation, which pointed towards a tuberculous lesion. There was neither clinical nor radiological evidence of pulmonary involvement. He was subsequently started on anti-tuberculous chemotherapy. Tuberculosis rarely involves wrist joint and is usually diagnosed in arthritic stage. Similar iteration showed that many patients had a diagnosis of rheumatoid arthritis or nonspecific synovitis prior to the diagnosis of tuberculosis, along with a striking lack of pulmonary symptoms, and a profile which pointed towards tenosynovitis, or rheumatoid arthritis. The scaphoid is the least common bone in the wrist to be affected in a tuberculous focus due to its blood supply. We conclude, tuberculosis of the wrist, should be considered among patients with inflammatory complaints, even in the absence of pulmonary findings. No other case report has been reported on tuberculous reprobation of the scaphoid, from a tuberculous endemic country like India.