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Tuberculosis of the wrist is an uncommon clinical entity and mostly presents as insidious pain and swelling. Presentation of a singular carpal bone involvement as the sole feature of tuberculous infection is a relatively uncommon event. In this report the authors describe a case of scaphoid fracture in a 20‑year‑old male patient, and underlying tuberculous infection suspected by ultrasonographic examination of the wrist joint, magnetic resonance imaging and guided aspiration and culture of the joint fluid. Introducing anti tuberculous drugs under appropriate supervision resulted in clinical improvement and optimal regain of function. No reactivation of the disease was noted in a follow‑up of 2 years. This case highlights a rare presentation of tuberculosis presenting with a fracture of scaphoid.
The patient was referred to rheumatology and rehabilitation outpatient clinic for musculoskeletal and ultrasonographic assessment. Clinical history and examination were done supported by musculoskeletal US which revealed significant villous like synovial thickening with increased vascularity. Scaphoidectomy, wire fixation and synovectomy of extensor compartment were done at the orthopedic clinic. Review of the history for the present illness, the patient gave history of loss of weight despite of good appetite, vague history of unmeasured fever, more in the morning not associated with skin rash, rigors or excessive night sweats and not associated with an evident source of infection. There was no history of subcutaneous nodules, no other joint or musculoskeletal complaints of significance. There was no history of alopecia, oral ulcers, genital ulcers, malar rash, photosensitivity or Raynaud’s phenomenon, no history of DVT, TIAs, stroke or any vascular event, no history of cough, hemoptysis or dyspnea. No history of tingling, hypothesia or muscle weakness, no history of chronic diarrhea or change of bowel habits or GIT bleeding. No history of bleeding from anybody orifices (Figure 2).
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