Ann Arthritis Clin Rheumatol | Volume 1, Issue 1 | Case Report | Open Access
Hein YP, Keen HI
Fiona Stanley Hospital, Australia
*Correspondance to: Yee Phyo Hein
Fulltext PDFTenosynovitis consists of inflammation of a tendon and its synovial sheath secondary to infectious and non-infectious causes. We present 2 cases of atypical infections that presented as isolated wrist tenosynovitis associated with a long-term delay in identifying underlying atypical infections. One of the cases presented consisted of atypical mycobacteria, and the other involved sporotrichosis. In each case, no organism was cultured from tendon sheath aspirates. Short-term benefit was derived from injected and oral glucocorticoids in each case. Atypical infections, although uncommon, can be easily mistaken for more common immune-mediated rheumatic diseases because the clinical manifestations overlap. These cases illustrate that atypical infection should be considered with a high degree of suspicion in cases of isolated wrist tenosynovitis. Furthermore, it shows that the demonstrated short-term benefit of glucocorticoids does not exclude infection and that both aspirate of the fluid and biopsy can often be culture-negative, thus eluding detection by clinical diagnostics. A high index of suspicion and biopsy, sometimes with repeated sampling, may be necessary to achieve a diagnosis.
Hein YP, Keen HI. Atypical Infections of Tenosynovitis. Ann Arthritis Clin Rheumatol. 2018; 1(1): 1004.