Tuberculous Chronic Palmar Bursitis and Flexor Tenosynovitis of the Wrist: A Case Report

Palmar bursitis and tenosynovitis of the flexor tendon sheath around the wrist is a rare manifestation of musculoskeletal tuberculosis. It has an indolent course and diagnosis is often delayed especially when it is an isolated finding. Timely diagnosis can prevent complications like bony involvement, tendon rupture and neuropathy. Here, we report a case of a 42-year-old male patient who presented with gradually progressive painful swelling of the left palm, wrist and distal forearm. Ultrasound and MRI revealed synovial thickening and distension of the palmar bursae and flexor tendon sheath with fluid and rice bodies. Open excisional biopsy was done, and thickened synovium and rice bodies were removed. Histopathology showed epithelioid granulomas with Langhans type giant cells and caseation necrosis. Anti-tubercular therapy was administered, and on follow-up, there was no recurrence of symptoms.