Granulomatous Tenosynovitis Research Articles

Chronic eosinophilic granulomatous tenosynovitis in a Quarter Horse mare

SummaryA 5‐year‐old Quarter Horse mare was presented to the Michigan State University Equine Surgery Service for evaluation of a right hind metatarsophalangeal joint injury. On presentation, the horse was a grade 4/5 lame. Radiographs and ultrasonography showed peritendinous ossification/mineralisation of soft tissue structures and digital flexor tenosynovitis with profound intracapsular mineralisation. A digital flexor tendon sheath tenoscopy was performed with a plantar annular ligament desmotomy and a manica flexoria ligament tenotomy. During surgery, a significant amount of tan granular material was found within the digital tendon sheath. Approximately 80% of this material was removed, and a sample was sent for histopathology. The horse was diagnosed with eosinophilic granulomatous tenosynovitis. Long‐term follow‐up revealed improvement with four treatments of intralesional triamcinolone given 2–4 weeks apart. The horse became serviceably sound (grade 1/5) and was beginning light work under the saddle approximately 5 months post‐tenoscopy.

Three cases of successful treatment of granulomatous tenosynovitis

Granulomatous tenosynovitis is a rare disease with an indolent, relapsing process, which can be caused by various pathogens. Here, we describe three immunocompetent patients with right wrist granulomatous tenosynovitis. Two cases were attributed to nontuberculous mycobacteria (NTM) infection. In the third case, no definite etiology was found. However, the symptoms and patient history were similar to the other two cases. All three patients were cured by surgical debridement and clarithromycin-based anti-NTM antibiotics.

53-Year-Old Man With a Swollen Finger

53-Year-Old Man With a Swollen Finger

Sarcoidal granulomatous tenosynovitis of the hands occurring in an organ transplant patient

Six years after kidney-pancreas transplant, a 47-year-old white man developed multiple subcutaneous and tenosynovial nodules of hands and wrists, limiting mobility. Biopsy of multiple nodules showed fibrosing, sarcoidal granulomas, some of which contained pigmented material. Microbiology, immunohistochemistry, scanning electron microscopy with backscattered electron imaging and energy dispersive X-ray analysis and polymerase chain reaction assays failed to show any infectious agents or foreign material. There was no historical, clinical or laboratory evidence of systemic sarcoidosis. It is not known whether the donor had sarcoidosis. Despite empiric antimycobacterial therapy and ongoing immunosuppressive therapy (corticosteroids, mycophenolate, cyclosporine), the man has progressively developed more nodules, limiting hand function. Sarcoidosis occurring in non-donor tissue post-transplantation is an exceedingly rare complication of transplantation. We discuss this case and review the literature on sarcoidal tenosynovitis and sarcoidosis occurring post-transplantation.

Mycobacterium marinum as a cause of chronic granulomatous tenosynovitis in the hand

Mycobacterium marinum is an uncommon cause of chronic granulomatous flexor tenosynovitis and leads to significant morbidity in the hand. This paper aims to review our treatment of this infection and its clinical outcomes. We treated five cases of M. marinum flexor tenosynovitis from 2001 to 2006, which were confirmed after 6 weeks of mycobacterial culture. All the patients were healthy immuno-competent hosts. There was a history of injury by a marine animal in each patient. Presentation was delayed at an average of 32.0 days after the injury. Excisional debridement was performed at an average of 63.4 days after the injury. The average number of debridements performed was 3.4. One patient had to undergo ray amputation to control the infection. The average duration of oral antibiotics was 15.4 weeks. Post-operatively, there were reductions in total active motion in all patients. A high index of suspicion, based on the history and intra-operative findings, is necessary when managing these patients. This infection runs a protracted course that requires multiple debridements and is associated with poor functional outcome.

Recurrent granulomatous tenosynovitis of the wrist and finger caused by Mycobacterium intracellulare: a case report

We report a 65-year-old man with tenosynovitis of the wrist and finger caused by Mycobacterium intracellulare. The diagnosis was made after subsequent recurrence, when a specimen of synovial fluid was subjected to specific polymerase chain reaction and mycobacterial culture. Synovectomy and susceptibility-guided antituberculous therapy permitted complete healing of tenosynovitis.

Mycobacterium intracellulare as a cause of a recurrent granulomatous tenosynovitis of the hand

We report a case of recurrent granulomatous tenosynovitis with M. intracellulare in a 55-year-old HIV negative diabetic woman. Identification of the causative agent further than belonging to the M. avium-intracellulare complex is provided by specific PCR-amplification of genomic DNA and sequencing of an hypervariable region within its 16S RNA gene. Sixteen months antibiotic regimen of rifabutin and clarythromycin led to a complete resolution of the tenosynovitis.

Localized Soft-Tissue Infections with Mycobacterium avium/Mycobacterium intracellulare Complex in Immunocompetent Patients: Granulomatous Tenosynovitis of the Hand or Wrist

In immunocompetent patients, Mycobacterium avium/Mycobacterium intracellulare complex (MAC) has been associated with pulmonary infection in adults, cervical lymphadenitis in children, and disseminated infection in children and adults. MAC rarely has been recognized as a cause of localized soft-tissue infection in immunocompetent hosts. Six cases of granulomatous tenosynovitis due to MAC are reported; five cases occurred after local surgical procedures, trauma, or corticosteroid injection. In four cases, cure was achieved with combined medical and surgical intervention. In these six cases and 11 previously reported cases, both males and females were affected equally, usually in the fifth to seventh decades of life, and the distal upper extremity was predominantly involved. Surgical debridement with appropriate culture was critical for diagnosis and management. Antimycobacterial chemotherapy seemed to be a beneficial adjunctive measure in most cases but was clearly necessary for cure in only a few cases.

Granulomatous Tophaceous Gout Mimicking Tuberculous Tenosynovitis: Report of Two Cases

Granulomatous inflammation in a tissue specimen raises concern about infection with Mycobacterium tuberculosis, atypical mycobacteria, certain fungi, Brucella species, and other infectious agents. Inflammatory disorders, such as sarcoidosis, crystal-associated arthritis, or foreign body reactions also are considered when granulomatous changes are seen on histological examination of a tissue specimen. We describe two cases of granulomatous tenosynovitis due to tophaceous deposits in patients with gout. In one case, tuberculous synovitis was considered the primary diagnosis until the diagnosis of gout was confirmed by examination of a tissue specimen with polarized light. In the second case, gout and tuberculosis were found in the patient's wrist joint. After antituberculous therapy was discontinued, he continued to have wrist synovitis and chronic drainage due to granulomatous tophaceous gout. The findings in this report suggest that gouty tenosynovitis can mimic tuberculous tenosynovitis and that gout should be considered in the differential diagnosis of granulomatous tenosynovitis, especially when acid-fast stains and cultures are negative for mycobacteria.

Granulomatous tenosynovitis and carpal tunnel syndrome caused by sporothrix schenckii

Although the usual form of sporotrichosis is a lymphocutaneous lesion, Sporothrix schenckii can cause articular disease that is difficult to diagnose. We describe two patients with sporotrichosis who presented with tenosynovitis and the carpal tunnel syndrome. A tissue specimen is required for a precise diagnosis; granulomatous tenosynovitis suggests an infectious cause. Unless appropriate cultures for bacteria, mycobacteria and fungi are obtained, the diagnosis may be missed or delayed. Mouse inoculations may be required to isolate S. schenckii from tissue, which rarely shows the delicate fungus in histologic sections. Our patients were cured by a combination of synovectomy and the intravenous administration of amphotericin B. Sporotrichosis should be considered in the differential diagnosis of the carpal tunnel syndrome, particularly when surgical exploration discloses a granulomatous tenosynovitis.

Granulomatous tenosynovitis and carpal tunnel syndrome caused by sporothrix schenckii: Stratton CW, Lichtenstein KA, Lowenstein SR, Phelps DB, Relier LB: Am J Med 1981; 71: 161–164

Granulomatous tenosynovitis and carpal tunnel syndrome caused by sporothrix schenckii: Stratton CW, Lichtenstein KA, Lowenstein SR, Phelps DB, Relier LB: Am J Med 1981; 71: 161–164

Granulomatous Tenosynovitis Due to Beryllium Histological and Spectrographic Analysis

A case of granulomatous tenosynovitis of the flexor tendon sheath of a finger following a cut by a broken fluorescent bulb has been presented. The histological and spectrographic evidence indicate that beryllium was the causative agent. (The process took at least five, and probably seven,years before clinical manifestations appeared.) If contamination of a synovial surface by beryllium is known to have occurred, the possibility that severe synovitis may develop should be borne in mind when considering the patient's prognosis. Great care should be exercised to prevent contamination of synovial surfaces during the treatment of wounds believed to be soiled with beryllium.