A 59-year-old male patient was admitted to the emergency department because granulomatous tissue was present during surgery.
The same patient reported paresthesia of the right fingers for 12 months 1.2.3, which increased at night, associated with mild limitation in mobility of the fingers and the radius joint.
In addition, the Tinel sign was positive on examination.
The neurophysiological study was compatible with a tunnel syndrome.
In the absence of improvement with medication and physiotherapy, the median nerve should be punished, during which procedure it is shown that the nerve is enclosed in a grey mass of amorphous tissue, which was resected.
The histological study reports granulomatous synovitis with Langhans cells and foci of necrosis.
Fite Faraco staining was negative.
Histological elements suggest tuberculosis or sarcoidosis.
In the evaluation, the patient reported being a smoker of 1 c daily intake for 40 years and 350 mL of rum every 3 days.
For approximately 2 months she has had a wet cough, which has been associated with mucopurulent expectoration in the last 10 days.
He also reported loss of appetite and weight, without specifying the amount of appetite.
The examination revealed crackling rales in the right lung base, weight 68.18 kg, body mass index (weight kg)/(height m2) of 24.17 kg/m2.
In the right lung base, sputum with acid-fast bacilli resistant encoding 8 (scale up to 10), erythrocyte sedimentation rate in 125 mm/h and chest X-ray with inflammatory lesions are highlighted.
Sputum culture confirmed the presence of M. tuberculosis, which confirmed the diagnosis.
