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An Unusual Tenosynovitis Agent of the Hand: Tuberculosis Tenosynovitis

Tuberculosis (TB) is a disease that mainly affects the lungs and is primarily caused by Mycobacterium tuberculosis bacteria. However, the hand involvement is extremely rare. Diagnosing the tenosynovitis due to the tuberculosis is the main challenge for the surgeons. It is aimed to present a case of Mycobacterium tenosynovitis of the hand and outline the treatment protocol for its diagnosis. 
46-year-old male patient was presented with swelling in his right hand. Physical examination revealed no pathology except for swelling in the right thenar region. Magnetic resonance imaging (MRI) revealed chronic tenosynovitis. Synovectomy was planned for the patient, and following the thenar incision, mass formations in the form of pale-yellow rice grains were found inside the thickened sheath of the flexor pollicis longus. Since these formations suggested TT intraoperatively, the intraoperative wound culture, samples for acid-resistant staining, TB DNA, and TB culture, as well as pathology samples, were taken. 
Intraoperative suspicion of TT is extremely important in order to prove the diagnosis. Although TB that affects the hand is rare, it is an element of tenosynovitis that must be kept in mind in areas where TB is endemic. Rice bodies are important guiding agents for intraoperative diagnosis and subsequent treatment.