A rare localization of tuberculosis of wrist joint and sternoclavicular joint

Shubham Mishra

Abstract

A rare localization of tuberculosis of wrist joint and sternoclavicular joint

Background: Tuberculosis (TB) is major public health issue globally especially in developing countries like India. Though pulmonary TB is common the extra pulmonary TB is also on the rise. The author presents two rare case of tuberculosis of wrist joint and sternoclavicular joint in two separate patients whose early diagnosis and treatment was done.

Case History: The author presents a case 1 of a 30-year-old and case 2 of a 45-year-old female in outpatient department presented a progressively pain and swelling of the right wrist and front of sternoclavicular joint. Both of them did not have a previous history of tuberculosis. However, both of them have erythrocyte sedimentation rate, high and Mantoux (purified protein derivative) test was strongly positive (more than 15 mm). Radiograph of ulna, radius, and wrist showed osteopenic changes around the distal radius case 2 patient shows oblique view of left sternoclavicular joint showed irregularly moth-eaten appearance of sternal end of clavicle and mild sclerosis of articular surface of manubrium osteopenic changes in sternoclavicular joint. Excision biopsy of the mass was done and samples sent for histopathology comment. The findings were an inflamed, thickened synovia with rice bodies: suggestive of tuberculous tenosynovitis. Anti-tuberculous chemotherapy was commenced on the second postoperative day.

Result & Conclusion: Tuberculous arthritis of the wrist is a rare condition. Diagnosis is often difficult due to slow progression and nonspecific symptoms. Definitive diagnosis depends on histopathological examination and microbiological confirmation. Antituberculosis treatment is effective, but the functional outcome depends on early diagnosis before the development of radiological evidence of joint destruction. Tuberculous etiology should be considered for patients presenting with atypical sites of skeletal inflammation, and a high index of suspicion by the treating physician is necessary to make early diagnosis and appropriate treatment.