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. 2013 Sep 27:3:37.
doi: 10.4103/2156-7514.119015. eCollection 2013.

Isolated tuberculous tenosynovitis of the anterior tibial and extensor digitorum longus tendons

Berhan Genç  1 , Aynur Solak, Aslan Mayda, Nazime Sen
Affiliations

Isolated tuberculous tenosynovitis of the anterior tibial and extensor digitorum longus tendons

Berhan Genç et al. J Clin Imaging Sci. .

Abstract

Musculoskeletal system is involved in 1-5% of extrapulmonary cases of tuberculosis. Tuberculous tenosynovitis is a rare form of musculoskeletal tuberculosis. Tuberculosis of the tendon sheath in the hand has been seen in a few cases. Involvement of the tendons of the leg is less common. Diagnosis is not easy as there are no specific clinical symptoms or signs. A 33-year-old male presented with painful swelling in the distal right lower limb that caused restriction of movement. Imaging studies showed inflammation and infection of the extensor digitorium longus and tibialis anterior tendons. Histopathological studies showed a necrotizing granulomatous inflammation in the synovial tissue. A diagnosis of tuberculosis was made and medical treatment was initiated that proved successful. Patient remained infection-free at 26-month follow-up examination.

Keywords: Foot; tenosynovitis; tuberculosis.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
33-year-old man with painful swelling in the right ankle diagnosed with tuberculous tenosynovitis. (a) Pre-contrast and (b) post-contrast coronal T1-weighted images with gadolinium enhancement show tenosynovitis in the distal portion of the lower limb – thickening of the extensor digitorum longus (white arrows) and anterior tibial (arrow heads) tendons.
Figure 2
Figure 2
33-year-old man with painful swelling in the right ankle diagnosed with tuberculous tenosynovitis. (a) Pre-contrast and (b) post-contrast Axial T1-weighted images at the level of the right tibiotalar joint demonstrate contrast enhancement of the extensor digitorum longus (black arrows) and tibialis anterior tendons (arrow heads) and surrounding smooth tissue. The extensor hallucis longus tendon is normal (white star).
Figure 3
Figure 3
33-year-old man with painful swelling in the right ankle diagnosed with tuberculous tenosynovitis. Axial fat-suppressed T2-weighted MR images at the level of the right tibiotalar joint shows thickening of the extensor digitorum longus (arrows) and tibialis anterior tendons (arrow heads), peritendinous edema and minimal fluid within the synovial sheath, edema in the surrounding subcutaneous tissues with loss of fat planes and increased signal intensity within the tendons.
Figure 4
Figure 4
33-year-old man with painful swelling in the right ankle diagnosed with tuberculous tenosynovitis. Photomicrograph of a histopathological section of the synovium stained with hematoxylin-eosin (×100) shows casseous necrosis with granuloma formation (black arrow), typical of tuberculosis infection.
See this image and copyright information in PMC

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