Tuberculosis of wrist joint with rice body formation: A case report

Abstract

Tuberculosis of the wrist and hand is a rare infectious disease, Because of the rarity of these cases, early diagnosis is often difficult. We report a case of 55-year-old male agriculture worker came to our OPD due to a palpable tumor mass over his right wrist which had progressively enlarged since 2 years ago. He had mild pain and swelling on the volar aspect of the wrist and radial side of hand, he also complains of pain and inability to do movements in the right thumb. The patient had no history of systemic disease, or tuberculosis. Radiography showed a soft-tissue mass shadow, with destruction of wrist joint and osteoporosis, and magnetic resonance imaging was not done because of patient non-affordability with financial constraints. Laboratory test results were normal, except for an elevated erythrocyte sedimentation rate. The patient had an ambiguous Mantoux test result but no history of mycobacterial exposure. Investigations for rheumatic disease were negative. Surgical exploration of the lesion revealed rice bodies in the common flexor tendon synovial sheath, extending up to meta-carpo phalangeal joint of thumb. Removal of the rice bodies and thorough excision of the sheath was performed and Joshis external stabilization system (JESS) was applied. The patient regained a painless restricted range of motion in about 6 months. One-year follow-up revealed no underlying disorder.