El bileği tüberküloz enfeksiyonu

El bileği tüberküloz enfeksiyonu nadir görülmektedir. Bağışıklık sistemi baskılanmış kişilerin artışı ve ilaca dirençli bakterilerin ortaya çıkışı akciğer dışı mikobakteriyel enfeksiyon insidansını son on yılda oldukça arttırmıştır. El bileği tüberküloz enfeksiyonunun tanısı zor olup özellikle hastada belirgin risk faktörlerinin olmasıyla tüberkülozdan şüphe edilmesi gerekmektedir. Hızlı tanı konulması ve tedavi esas olup tedavisiz kalan el bileği tüberküloz olguları destrüktif osteoartiküler sonuçlar ile yüz yüze kalabilir. Tüberküloz tenosinovitine genelde erken tanı konulamaz ve yumuşak doku tümörlerinden ayırıcı tanısı klinik olarak çok güçtür. Manyetik rezonans, tüberküloz tenosinovitine erken tanı konulmasında ve tedavinin planlanması aşamalarında kullanışlıdır. Bu yazıda, el bileği tüberküloz enfeksiyonu tanısı alan orta yaşlı bir erkek olgu manyetik rezonans görüntüleme bulguları eşliğinde sunulmaktadır.

Tuberculous infection of the wrist

Tuberculous infection of the wrist is a rare disorder. Because of the increased number of immunocompromised individuals and drug-resistant bacterial strains, the incidence of extrapulmonary mycobacterial infection has gradually increased over the past decade. The diagnosis of tuberculous infection of the wrist may be difficult and requires a high index of suspicion, especially in patients with significant risk factors. Prompt diagnosis and treatment are crucial, as untreated wrist infections can have destructive osteoarticular outcomes. Tuberculous tenosynovitis is often not diagnosed early, and its differentiation from soft tissue tumors may be clinically difficult. MRI, is useful for early diagnosis of, and planning treatment for, tuberculous tenosynovitis. This report presents a case of a middle-aged man with tuberculous infection of the wrist, and highlights the magnetic resonace imaging seen in this case.

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1. Lee SH, Abramson SB. Infections of the musculoskeletal system by M. tuberculosis. In: Rom WN, Garay SM, eds. Tuberculosis. New York, NY: Little, Brown and Company, 1996;635-644.
2. Watts HG, Lifso RM. Current concepts review: tuberculosis of bones and joints. J Bone Joint Surg Am1996;78:288-298.
3. Hoff man KL, Bergman AG, Hoff man DK et al. Tuberculous tenosynovitis of the fl exor tendons of the wrist: MR imaging with pathologic correlation. Skeletal Radiol 1996;25:186-188.
4. Lakhanpal S, Linscheid RL, Ferguson RH et al. Tuberculous fasciitis with tenosynovitis. J Rheumatol 1987;14:621-624.
5. Hunfeld KP, Rittmeister M, Wichelhaus TA et al. Two cases of chronic arthritis of the forearm due to Mycobacterium tuberculosis. Eur J Clin Microbiol Infect Dis1998;17:344-348.
6. Jaovisidha S, Chen C, Ryu KN, et al. Tuberculous tenosynovitis and bursitis: imaging fi ndings in 21 cases. Radiology 1996;201:507-513.
7. Hsu CY, Lu HC, Shih TT. Tuberculous infection of the wrist: MRI features. AJR Am J Roentgenol 2004;183:623-628.
8. Sawlani V, Chandra T, Mishra RN et al. MRI features of tuberculosis of peripheral joints. Clin Radiol 2003;58:755-762.
9. Lee KE. Tuberculosis presenting as carpal tunnel syndrome. J Hand Surg Am 1985;10:242-245.
10. Wongworawat MD, Holtom P, Learch TJ et al. A prolonged case of Mycobacterium marinum fl exor tenosynovitis: radiographic and histological correlation, and review of the literature. Skeletal Radiol 2003;32:542-545.