Downloaded from https://academic.oup.com/rheumatology/advance-article-abstract/doi/10.1093/rheumatology/kez115/5423002 by Ed 'DeepDyve' Gillespie user on 02 April 2019 Rheumatology 2019;0:1 Clinical vignette doi:10.1093/rheumatology/kez115 Acknowledgements A 38-year-old man was referred because of persistent Jean-Baptiste Vulsteke holds a Research Foundation swelling of the dorsal side of the right hand for 8 months, Flanders (FWO) Strategic Basic Research Fellowship without fever or pain. He was treated with ciclosporin and was supported by a grant from the Joe ¨ l Hurlet Fund. and methylprednisolone for autoimmune hepatitis, com- Funding: No specific funding was received from any fund- plicated by cirrhosis, diagnosed 20 years ago. Physical ing bodies in the public, commercial or not-for-profit sec- examination showed a pronounced swelling of the dorsal tors to carry out the work described in this article. side of the right hand (Fig. 1). MRI was previously per- formed after 4 months of swelling and showed mild to Disclosure statement: The authors have declared no moderate tenosynovitis of the tendons of the extensor conflicts of interest. digitorum muscles. The swelling persisted despite NSAIDs and cast immobilization. X-ray of the hands 1,2 3 Jean-Baptiste Vulsteke , Chris Verslype and demonstrated no erosions. At referral, he had a discrete 1,2 9 9 Ellen De Langhe leucopenia (3.89 10 /l, range 410 10 /l) with 9 9 lymphocytopenia (0.5 10 /l, range 1.23.6 10 /l) Rheumatology, University Hospitals Leuven, Leuven, and normal CRP concentration. Given the high Belgium, Skeletal Biology and Engineering Center, Department of Development and Regeneration, KU Leuven, index of suspicion for an opportunistic infection, a Leuven, Belgium and Gastroenterology and Hepatology, tenosynovial biopsy and limited synovectomy were per- University Hospitals Leuven, Leuven, Belgium formed. Culture of the tenosynovial tissue and a peri- operative fluid aspirate were both positive for Candida Correspondence to: Ellen De Langhe Rheumatology, albicans sensitive to fluconazole. Pan-bacterial PCR, University Hospitals Leuven, Herestraat 49, Leuven, Belgium. ZiehlNeelsen stain and mycobacterial PCR of the teno- Email: firstname.lastname@example.org synovial tissue were negative. There were no clinical signs of mucocutaneous candidiasis. Blood cultures were negative. Transthoracic echocardiography did not References show signs of endocarditis. Treatment with oral flucon- azole (800 mg loading dose followed by 200 mg twice a 1 Yuan RTW, Cohen MJ. Candida albicans tenosynovitis of day for 6 weeks) was initiated. At 10 weeks there was the hand. J Hand Surg Am 1985;10:71922. complete resolution of the tenosynovitis. Fungal teno- 2 De Pooter J, Ommeslag D, Van Den Abeele A, Callens S. A synovitis of the hand, especially due to Candida albicans, rare case of Candida tenosynovitis successful suppressed is rare, with only a few cases documented in literature [1, 2]. with voriconazole after fluconazole failure. Case report Nevertheless, a high index of suspicion is warranted in and review of literature. Internet J Infect Dis 2013;12. tenosynovitis in immunocompromised patients. http://ispub.com/IJID/12/2/2977. FIG.1 Tenosynovitis of the right hand. The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: email@example.com
Rheumatology – Oxford University Press
Published: Mar 29, 2019
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