Clinical characteristics and treatment outcomes of tuberculous tenosynovitis of the hand and wrist.

Objective: Vietnam is endemic with tuberculosis (TB), which is highly prevalent in the community. TB tenosynovitis of the wrist and hand is uncommon. Because of its insidious progression and atypical presentations, it is often difficult to diagnose, leading to treatment delays. This study investigates the characteristics of clinical and subclinical signs and treatment outcomes of patients with TB tenosynovitis in Vietnam. Patients and Methods: This prospective longitudinal cross-sectional study included 25 TB tenosynovitis patients in the Rheumatology Clinic at University Medical Center Ho Chi Minh City. The diagnosis was made based on a tuberculous cyst in histopathological specimens. The data were collected through medical history, physical examination, and medical records, including demographics, signs, symptoms, condition duration, and related laboratory tests and imaging. The outcomes of all participants were assessed after 12 months of treatment. Results: The most common symptom of TB tenosynovitis was swelling of the hand and wrist, which was present in all patients. Its other symptoms included mild pain and numbness of the hand in 72% and 24% of patients, respectively. It can affect any site on the hand. Hand ultrasound findings included thickening of the synovial membrane (80%), peritendinous effusion (64%), and soft tissue swelling (88%). Most patients (18/22) had a good outcome after the treatment with anti-tubercular drugs. Conclusions: TB tenosynovitis progression is often insidious. Its most common symptoms are swelling of the hand and mild pain. Ultrasound is a useful tool to support the diagnosis. A histological examination confirms the diagnosis. Most cases respond and have a good outcome after 9-12 months of anti-tuberculosis treatment.

Active pulmonary tuberculosis in a patient with secukinumab treatment.

Numerous investigations have documented active tuberculosis (TB) infection following biologic treatment. One of the most secure biologic medications for infections is secukinumab. Additionally, no cases of active TB while receiving secukinumab therapy were recorded. Secukinumab 150 mg per month has been administered for a 19-year-old man with spondyloarthritis since May 2020. A diagnosis of pulmonary TB was made when the patient complained of a moderate fever, a productive cough, and weight loss after 2 years. His fever and respiratory symptoms were relieved after 6 weeks of treatment by stopping secukinumab and utilizing 4 antibiotics: isoniazid, rifampicin, pyrazinamide, and ethambutol, while non-steroidal anti-inflammatory drugs reduced his joint and back discomfort. During biological therapy, even with secukinumab, annual screening for latent and active TB is crucial. We require additional study on secukinumab-treated patients with active TB in nations with high TB burdens, including Vietnam.