Tuberculous compound palmar ganglion: unravelling a rare diagnosis

Tuberculous tenosynovitis is a rare manifestation of musculoskeletal tuberculosis, often misdiagnosed due to its indolent course and nonspecific presentation. Compound palmar ganglion, a chronic form of tuberculous tenosynovitis, can mimic benign conditions like ganglion cysts, leading to diagnostic delays, especially in immunocompromised individuals.

We report a case of a 35-year-old HIV-positive female who presented with a painless swelling on the volar aspect of the wrist for six months. MRI revealed flexor tendon thickening and synovial proliferation, raising suspicion of infectious tenosynovitis. Surgical excision was performed, and histopathological examination confirmed tuberculous tenosynovitis with caseous granulomas. Ziehl-Neelsen staining identified acid-fast bacilli, confirming the diagnosis. The patient was started on standard anti-tubercular therapy (ATT) and showed complete resolution of symptoms at six months.

Tuberculous compound palmar ganglion should be considered in chronic wrist swellings, particularly in endemic regions and immunocompromised patients. Early diagnosis using imaging and histopathology is crucial for timely management. A combination of surgical excision and ATT ensures favorable outcomes.