Diagnostic Challenges of Wrist Tuberculosis Without Pulmonary Involvement in a Non-endemic Area: A Case Report

Tuberculosis is a systemic infection caused by the Mycobacterium tuberculosis complex bacilli.Musculoskeletal tuberculosis of the wrist is rare among extrapulmonary tuberculosis and usually develops from hematogenous spread of reactivated pulmonary tuberculosis or from direct inoculation of bacilli into the tissues of the hand.Hand and wrist tuberculosis treatment consists of a pharmacologic regimen, surgery, or a combined treatment.We present a highly atypical case of an elderly man who was diagnosed with tuberculosis of the right wrist, with a delayed onset, a progressive and recalcitrant course, and, more importantly, without a pulmonary infection.Our patient underwent two surgical debridements in order to achieve an eventual diagnosis.The lack of pulmonary infection obscured the diagnostic procedure, which was initially directed at common bacterial pathogens.This delay in diagnosis led to severe bone and soft tissue involvement with extensive resorption of the carpal bones.Tissue biopsy and cultures are imperative for the diagnosis and antibiotic-guided treatment.A combined approach of surgical and antibiotic chemotherapy is preferred to optimize patient outcomes.A high index of suspicion is therefore imperative in the setting of a recalcitrant and progressive inflammatory arthropathy of the wrist joint, even without pulmonary involvement, and even in regions with declining tuberculosis infection rates.