Tuberculoma with phlegmon-like symptoms mimicking soft tissue sarcoma in the wrist: A case report

Despite the increasing incidence of tuberculosis, even in developed countries like Japan, tuberculoma is a relatively uncommon disease. Furthermore, given the rarity of tuberculoma, a definitive diagnosis is often delayed. We herein present the case of a 79-year-old man who presented with an erythematous and warm mass in the left forearm. Radiography revealed calcification of the wrist's volar side, and magnetic resonance imaging revealed a mosaic pattern at the lesion. Soft tissue sarcoma of the wrist was suspected, and an incisional biopsy was performed, which revealed numerous yellow rice bodies. A rapid pathological evaluation revealed caseous necrosis and Langhans giant cells, and a histological evaluation confirmed the diagnosis of tuberculoma. All the rice bodies were resected and the patient received postoperative antibiotic treatment with pyrazinamide, isoniazid, rifampicin and ethambutol. However, the patient developed hepatic insufficiency during treatment, and the regimen was discontinued. The patient had not experienced recurrence 1 year after the treatment. In conclusion, tuberculoma should be considered in the differential diagnosis of a wrist mass mimicking an inflamed soft tissue tumor.