Downloaded from https://academic.oup.com/rheumatology/article-abstract/58/10/1889/5423002 by Ed 'DeepDyve' Gillespie user on 01 October 2019 Rheumatology 2019;58:1889 doi:10.1093/rheumatology/kez115 Clinical vignette Advance Access publication 29 March 2019 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 Joel 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 1 2 lymphocytopenia (0.5 10 /l, range 1.23.6 10 /l) Rheumatology, University Hospitals Leuven, Skeletal Biology and Engineering Center, Department of and normal CRP concentration. Given the high Development and Regeneration, KU Leuven and index of suspicion for an opportunistic infection, a Gastroenterology and Hepatology, University Hospitals tenosynovial biopsy and limited synovectomy were per- 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: email@example.com 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: firstname.lastname@example.org
Rheumatology – Oxford University Press
Published: Oct 1, 2019
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