Tenosynovitis of the wrist and thumb and carpal tunnel syndrome caused by Histoplasma capsulatum: case report and review of the literature

Abstract

A patient presenting with acute carpal tunnel syndrome and swelling and pain in the wrist and thumb is presented. An open carpal tunnel release and tenosynovectomy were performed with biopsy specimen revealing infection with Histoplasma capsulatum. The case is discussed in context of the prior scant literature of tenosynovitis of the wrist and hand caused by histoplasmosis.

Fig. 1

a and b. PA and lateral radiographs of the hand and wrist

Fig. 2

a and b. PA and lateral radiographs of the thumb

Fig. 3

a–d. Axial T2 images of the right wrist at the level of the distal forearm (a) carpal tunnel (b) and palm (c) as well as sagittal images of the right wrist and hand (d) revealing marked flexor tendon thickening and edema

Fig. 4

a and b. Intraoperative photographs of the right wrist and hand revealing abundant tenosynovitis at the level of the distal forearm, carpal tunnel, and palm

Fig. 5

Biopsy specimen of the right wrist. Low-power view reveals a vaguely nodular process in a background of synovial and fibrovascular tissue (a). At high magnification, the nodules are comprised of clusters of multinucleated giant cells surrounded by a rim of lymphocytes, plasma cells, and histiocytes (b). These morphologic features are consistent with non-necrotizing granulomatous inflammation. Stains for microorganisms (Grocott’s methenamine silver, acid fast bacilli) were negative (not shown), and no foreign body material was appreciated under polarized light. Magnification ×40 (a), ×200 (b). Courtesy of Dr. Anja C. Roden, Mayo Clinic Rochester, MN

Fig. 6

Clinical photograph of the appearance of the affected right hand at 6 months postoperatively compared to the unaffected left hand