Forearm intramuscular tuberculosis of flexor digitorum profundus: a case report
DOI:
https://doi.org/10.18203/2349-2902.isj20151119Keywords:
Intramuscular, Tuberculosis, MRI, ImmunocompetantAbstract
Tuberculosis is one of the most commonly occurring infectious disorders in the developing countries like India, which literally can affect any organ and system. Primary tuberculous myositis is used to describe the clinical situation in which the most prominent lesion in the course of haematogenous tuberculosis involves the muscle and not the fact that the infection occurred primarily in the muscle. Tubercular pyomyositis is the least frequent extra spinal musculoskeletal tuberculosis reported in literature. We came across a 15 year old female without any known primary pulmonary or lymphoid foci who presented with a swelling and pain over right forearm since 3 months. After running all the radiological investigations and nerve conduction studies and taking under consideration the various differentials of the swelling, finally the swelling was excised and histopathology of the excised specimen was performed which suggested that the swelling was due to primary tuberculosis of the muscle and the underlying subcutaneous tissue and after that patient received anti tuberculosis regimen for 9 months and no recurrence of the disease was noted till date. This rare case is presented with review of literature.
References
Soler R, Rodrugueze E, Remuinan C, Sentos M. MRI of musculoskeletal extraspinal tuberculosis. J Compu Assis Tomogr. 2001;25:177-83.
Farer LS, Lowell AM, Meador MP. Extrapulmonary tuberculosis in the United States. Am J Epidemiol. 1979;109:205-17.
Sen RK, Tripathy SK, Deivaraju C. Isolated focal pyomyositis of teres minor:an unusual presentation of tuberculosis. Acta Orthop Traumatol Turc. 2011;45:276-9.
Wang JY, Lee LN, Hsueh PR, Shih JY, Chang YL, Yang PC and Luh K.T. Tuberculous myositis: a rare but existing clinical entity. Rheumatology. 2003:42:836-40
Petter CK. Some thoughts on tuberculosis of fascia and muscle. Lancet. 1937;57:156-9.
Goldblatt M, Cremin BJ. Osteo-articular tuberculosis: it’s presentation in coloured races. Clin Radiol. 1978;29:669-77.
Culotta A. La-tuberculosis muscuolare. Rev Pathol Tuberc. 1929;3:1-26.
Enarson DA Fujii M, Nakielna EM, Grzybowski S. Bone and joint tuberculosis: a continuing problem. Can Med Assoc J. 1979;120:139-45.
Puttick MP, Stein HB, Chan RMT, Elwood RK, How AR, Reid GD. Soft tissue tuberculosis: a series of 11 cases, J of Rheumatol. 1995;22(7):1321-5.
Ahmed J, Homans J. Tuberculous pyomyositis of the soleus muscle in a fifteen year old boy. Pediatric Infectious Diseases Journal. 2002;21(12):1169-71.
Chen WS. Tuberculosis of fascia lata, Clinical Rheumatology. 1998;17(1):77-8.
Sridhar C, Seith A. Tuberculous pyomyositis of the temporalis muscle. European Journal of Radiology Extra. 2004;52(3):89-91.
Sen RK, Tripathy SK, Dhatt S, Saini R, Aggarwal S, Agarwal A. Primary tuberculous pyomyositis of forearm muscle. Indian Journal of Tuberculosis. 2010;57(1):34-40.
Kim JY, Park YH, Choi KH, Park SH, Lee HY. MRI of tuberculous pyomyositis. Journal of Computer Assisted Tomography. 1999;23(3):454-7.
Masood S. Diagnosis of tuberculosis of bone and soft tissue by fine needle aspiration biopsy. Diagnostic Cytopathology. 1992;8(5):451-5.
Yao DC, Sartoris DJ. Musculoskeletal tuberculosis. Radiol Clin North Am. 1995;33:679-89.
Heycock JB, Noble TC. Four cases of syringe transmitted tuberculosis. Tubercle. 1961;42:25-7.
Vanhoenacker FM, Eyselbergs M, Van Dyck EV, De Schepper AM. Pseudotumoral soft tissue lesions of the hand and wrist: a pictoral review. Insights Imaging. 2011;2;319-33.
Yadav YK, Gupta O, Aggarwal R. Cytologiacal diagnosis of parasites presenting as superficial nodular swelling, report of 35 cases. J Parasit Dis. 2012;36(1):106-11.
Abdelwahab LF, Bianchi S, Martinoli C, Klein M, Hermann G. Atypical extraspinal musculosketal tuberculosis in immunocompetant patients: part II, tuberculous myositis, tuberculous bursitis and tuberculous tenosynovitis, “Canadian Association of Radiologists Journal. 2006;57(5):278-86.
Al Najar M, Obeidat F, Ajlouni J, Mithqal A, Hadidy A. Primary extensive pyomyositis in an immunocompetant patient: case report and literature review. Clin Rheumatology. 2010;29:1469-72.
Paajanen H, Grodd W, Revel D, Engelstad B, Brasch RC. Gadolinium-DTPA enhanced MR imaging of intramuscular abscesses. Magn Reson. Imaging. 1987;5:109-15.
Batra S, Ab Naell M, Barwick C, Kanvinde R. Tuberculous pyomyositis of the thigh masquerading as malignancy with concomitant tuberculous flexor tenosynovitis and dactylitis of the hand: Case Report. Singapore Med J. 2007;48(11):1042-6.
Theodorou DJ, Theodorou SJ, Kakitsubata Y. Skeletal muscle disease: patterns of MRI appearances. Br JRadiol. 2012;85:1298-308.
