A Misdiagnosis Report and Literature Review of Soft Tissues of Tuberculous Granuloma

WANG Xue-bin; LIN Gui-ying; FENG Xiu-gao; XU Xiang-jin

doi:10.3969/j.issn.1002-3429.2016.12.013

Abstract：Objective To investigate clinical features of soft tissues of tuberculous granulomas in order to reduce mis-diagnosis and mistreatment. Methods Clinical data of 1 misdiagnosed patient with soft tissues of tuberculous granulomas was retrospectively analyzed, and domestic and abroad literature was reviewed. Results The patient visited a doctor for arthralgia of right upper extremities accompanied by multiple subcutaneous tumors for more than 2 years. Medical examinations showed that erythrocyte sedimentation rate was 31. 0 mm/h, uric acid was 488. 9 μmol/L, and mycobacterium tuberculosisγ-interfer-on was 39. 6 pg/ml. Color doppler ultrasonography for body surface tumors showed that multiple cysts and mixed echoic area were found in right dorsum of hand and wrist. Plain scan combined with enhanced MRI showed that anomaly signal of right wrist and soft tissues of metacarpus. Tumors were excised and performed pathological examination, and the postoperative result was fitted mycobacterium tuberculosis infection, and then tuberculous granulomas was confirmed. The patient was discharged after conditions had improved by antituberculous treatment. Antituberculous treatment was continued after discharged, but the treatment was stopped because of significantly increased serum creatinine level, and the patient had no recurrence of arthrocele or subcutaneous tumors during 5 months of follow-up. Conclusion Soft tissues of tuberculous granulomas is rare in clinical practice. Mycobacterium tuberculosis interferon-γ release test and histologic examination for local tissue should be performed timely to effectively reduce misdiagnosis and mistreatment.