Isolated tuberculosis of the wrist: A rare case of extrapulmonary tuberculosis

Atypical infections with mycobacteria are unusual in the developed countries and tuberculous involvement of the wrist or carpal bones is a rare presentation. This is a new rare case of tuberculosis of the wrist joint in a non-immunocompromised 24-year-old male without concomitant pulmonary tuberculosis. He then underwent two months course of intra-articular steroid injections and methotrexate therapy for a presumed diagnosis of inflammatory oligoarthritis of the wrist as radiographs were reported as normal. The diagnosis was initially obscured by lack of systemic symptoms and was established by direct visualization of acid-fast bacilli on joint fluid and biopsy of the abscess. Musculoskeletal involvement in tuberculosis may be easily missed because of its non-specific clinical signs. The disease may mimic inflammatory arthritis and high index of suspicion is required when dealing with long standing inflammatory swellings. Persistent swelling of bones or joints can be a presenting sign of tuberculosis. A normal chest radiograph or the absence of systemic symptoms does not exclude the possibility of bone tuberculosis. When confronted with unusual inflammatory findings, always send tissue for histology and alcohol and acid-fast bacilli (AAFB) culture.