case_images: PMC9127846_01
case_images: Admission vitals and laboratory values.. WBC: white blood cell; BP: blood pressure; ESR: erythrocyte sedimentation rate; RR: respiratory rate; CRP: C-reactive protein; HbA1c: hemoglobin A1c; HIV: human immunodeficiency virus.
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case_images: Laboratory tests and vital signs were obtained, as shown in Figure 1.
case_images: Initial right wrist anteroposterior (AP) radiograph demonstrating significant osteopenia and degenerative changes across the joints of the wrist and carpus.
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case_images: The emergency department provider obtained radiographs of the right wrist (Figure 2).
case_images: Clinical photograph of the right wrist from the volar side (a) and the radial side (b). Images demonstrate erythematous area of fluctuance with overlying skin desquamation.
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case_images: It was erythematous and had developed desquamation of the skin around the lesion (Figure 3).
case_images: T2 MRI of the right wrist demonstrating signal change in the distal radius and carpal bones (a) as well as a fluid collection (b).
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case_images: A magnetic resonance image (MRI) with intravenous (IV) contrast was obtained to further characterize the lesion and its involvement (Figure 4).
case_images: Surgical pathology (a) and (b), demonstrating caseating granulomas.
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case_images: Following the first I&D, the whole blood QuantiFERON TB gold test returned as positive and preliminary pathology showed for caseating granulomas (Figure 5).
case_images: Clinical photograph of soft tissue defect (measuring approximately 2 cm x 6 cm) following final irrigation and debridement.
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case_images: The large volar fluctuance had created a sizable soft tissue defect that was not amenable to primary closure (Figure 6).
case_images: Two-month follow-up radiographs demonstrating diffuse osteopenia about right wrist and hand with advanced degenerative changes.
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case_images: RIPE therapy. Radiographs obtained from that follow-up appointment demonstrated severe degeneration of the right wrist and carpus with continued osteopenia (Figure 7).