Hidden in plain sight: the diagnostic dilemma of tuberculous synovitis: a case report

Tuberculous synovitis (TS) is an infrequent yet significant manifestation of tuberculosis (TB), particularly in regions where TB is endemic. The clinical presentation of TS is often nonspecific yet distinctive, and diagnosis is confirmed by histopathological examination. Anti-TB therapy is the cornerstone of treatment, although the necessity of surgical intervention remains debated. A case was reported of a 73-year-old female patient who complained of left wrist pain and swelling for the past 3 years. The left wrist was swollen from the metacarpophalangeal joints to the mid-forearm. Radiography on the left forearm revealed extensive, mixed predominant osteolytic and sclerotic bony lesions affecting all the carpal bones. These findings were associated with increased size of a hyperdense soft tissue swelling. Magnetic resonance imaging revealed rim-enhancing multiple encapsulated cystic fluid collections at the distal radioulnar and carpal regions. A biopsy of the left wrist was performed, revealing TS. The patient was subsequently started with anti-TB therapy.