Tuberculosis of the wrist mimicking rheumatoid arthritis - A rare case

Abstract

Introduction: Mycobacterium tuberculosis causes infection in approximately one-third of the world's population. Arthritis due to Mycobacteriurn tuberculosis usually presents as a chronic, slowly progressive, monoarticular infection that predominantly involves the weight-bearing joints and the spine. The hand and wrist are rare sites for tuberculosis (TB) and comprises of < 1% of all skeletal TB. Even though it is rare, TB of the wrist is a cause of great morbidity. We presented a case of wrist TB treated with debridement and synovectomy.

Presentation of case: A 35 years old woman came with the chief complaint of pain and swelling on the right wrist since 1 year ago and was diagnosed with rheumatoid arthritis of the wrist. Patient then was given methylprednisolone 4 mg twice a day and methotrexate 175 mg once a week. However, the pain and swelling of her right wrist became worse. Subsequently patient was admitted to hospital and laboratory findings suggested a tuberculous arthritis of the wrist. Debridement, synovectomy, and biopsy, in addition to antituberculosis therapy, were then performed.

Discussion: Tuberculous arthritis is generally a monoarticular disease that typically involves the spine or large and medium-sized joints. Rheumatoid arthritis (RA) and tuberculous arthritis may have similar clinical characteristics, which consists of a chronic course with periarticular soft-tissue swelling.

Conclusion: Tuberculous arthritis and RA can have similar characteristic but laboratory examination can help in establishing diagnosis.

Keywords: Debridement; Rheumatoid arthritis; Tuberculous arthritis; Wrist tuberculosis.

Fig. 1

Clinical manifestation of the Patient.

Fig. 2

X-Ray Examination of the Wrist.

Fig. 3

MRI of the wrist.

Fig. 4

Intraoperative Procedures.

Fig. 5

Postoperative X-Ray.