# Tuberculous tenosynovitis as the initial presentation of disseminated tuberculosis in a patient with uncontrolled diabetes: A case report and review of literature

## TL;DR

A woman with uncontrolled diabetes developed wrist tenosynovitis as the first sign of widespread tuberculosis, which was confirmed through biopsy and treated successfully with anti-tubercular therapy.

## Contribution

This case highlights a rare initial presentation of disseminated tuberculosis in a diabetic patient as wrist tenosynovitis.

## Key findings

- Tuberculous tenosynovitis was confirmed via histopathology and Gene Xpert testing for M. tuberculosis.
- The patient showed full functional recovery after starting anti-tubercular therapy.
- Uncontrolled diabetes was identified as a risk factor for disseminated tuberculosis.

## Abstract

A middle-aged woman with uncontrolled type 2 diabetes mellitus presented with pain in the right arm for 1 year, multiple gradually increasing painful swellings across her right wrist for 6 months, and intermittent fever of 3 months duration. She developed painful flexion and extension of the right ring and middle fingers as well as the right wrist. Physical examination revealed flexion contractures in the right and middle finger, mobile and non-tender axillary lymph nodes. Blood examination revealed an elevated erythrocyte sedimentation rate. An externally performed magnetic resonance imaging of the right wrist revealed multiple inflammatory swellings involving several tendon sheaths. A tendon sheath biopsy revealed multiple rice bodies within the tendon sheath. The tissue sample tested positive for acid-fast bacilli (AFB), and nucleic acid amplification test (NAAT/ Gene Xpert) result was positive. Chest radiography revealed bilateral infiltrates. The patient was initiated on anti-tubercular therapy with which she improved symptomatically.

•Rare presentation of extrapulmonary tuberculosis presenting as wrist tenosynovitis.•Uncontrolled diabetes predisposed to disseminated tuberculosis.•Definitive diagnosis often requires histopathological examination•Gene Xpert confirmed M. tuberculosis in both tendon and sputum samples•Early anti-tubercular therapy led to full functional recovery

Rare presentation of extrapulmonary tuberculosis presenting as wrist tenosynovitis.

Uncontrolled diabetes predisposed to disseminated tuberculosis.

Definitive diagnosis often requires histopathological examination

Gene Xpert confirmed M. tuberculosis in both tendon and sputum samples

Early anti-tubercular therapy led to full functional recovery