Journal of Guilan University of Medical Sciences
مجله علوم پزشکی گیلان
JGUMS
Literature & Humanities
http://journal.gums.ac.ir
1
admin
2383-4307
2423-4818
10.32598
fa
jalali
1399
3
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gregorian
2020
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29
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گزارش مورد نادر تنوسینوویت سلی کف دست در گیلان
A rare case of Tuberculous tenosynovitis in the palm of the hand in Gilan
تخصصي
Special
پژوهشي
Research
<strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">خانم</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">64</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">ساله</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">بدون</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">پیشینه بیماری</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">قبلی</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">از</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">نزدیک 5</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">ماه</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">پیش</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">دچار</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">تورم</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">بافت</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">نرم</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">سطوح</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">فلکسور</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">انگشت</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">دوم</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">دست</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">چپ</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">و</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">سطوح</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">پالمار</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">کف</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">همان</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">دست</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">بدون</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">درد</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">و</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">با</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">2</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">ندول</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">۱</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">در</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">۱</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">سانتی­متر</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">در</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">آن</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">ناحیه</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">شده</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">که</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">پس</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">از</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">دبریدمان</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">و</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">بیوپسی</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">اکسیژنال</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">و</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">بررسی</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">هیستوپاتولوژی</span></span></strong><strong><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:8.0pt;"> , </span></span></span></strong><strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">التهاب</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">گرانولوماتوز</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">نکروتایزینگ</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">کازئوز</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">گزارش</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">شد</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">و</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">زیر</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">درمان</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">ضد</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">سل</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">به</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">مدت</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">6 ماه</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">قرار</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">گرفت. </span></span></strong><br>
<strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">تنوسینوویت</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">سلی</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">در</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">کف</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">دست</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">ایجاد</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">می­شود</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">و</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">در</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">صورت</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;"> تشخیص­ندادن </span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">هنگام،</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;"> با</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">گسترش</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">به</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">بافت­های</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">نرم</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">مجاور، استخوان</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">و</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">مفصل</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">و</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">نشانگان تانل</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">کارپال</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">به</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">اختلال</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">کارکردی</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">دست</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">منجر</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">شود. تایید</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">تشخیص</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">با</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">بیوپسی</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">اکسیژنال</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">بافت</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">نرم</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">و</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">ندول</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">آن</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">و</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">بررسی هیستوپاتولوژی</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">و</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">کشت</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">باسیل اسید</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">فست</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">است. در</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">صورت</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">نداشتن درگیری</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">استخوان</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">و</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">مفاصل</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">با</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">درمان</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">ضد</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">سل</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">به</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">مدت</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">6</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">ماه</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">بهبود</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">می­یابد.</span></span></strong><strong><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:8.0pt;"></span></span></span></strong><br>
<strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">افزایش</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">آگاهی</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">و</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">ظن</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">تشخیصی</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">این</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">بیماری</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">تشخیص</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">به</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">موقع</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">و</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">درمان</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">مناسب</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">را به دنبال داشته و</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">از</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">اختلال</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">عملکردی</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">پیشگیری</span></span></strong> <strong><span style="font-family:B Zar;"><span style="font-size:8.0pt;">می­کند.</span></span></strong>
A 64-year-old woman with no history of previous illness presented with a soft tissue swelling of the flexor surfaces of the second finger of the left hand and also palmar surfaces of the same hand without pain and with 2 nodules 1 by 1 cm in that area for about 5 months. After debridement and excisional biopsy, histopathological examination reported caseous necrotizing granulomatous inflammation.The patient underwent anti-tuberculosis treatment for 6 months.Tuberculosis Tenosynovitis occurs in the palm of the hand. If not diagnosed early, it can lead to functional impairment of the hand by spreading to nearby soft tissues, bone and joint, and may lead to carpal tunnel syndrome. Confirmation of the diagnosis is by excisional biopsy of soft tissue and its nodules and sending for histopathologic examination and acid fast Mycobacterial culture. If the bones and joints are not involved, the anti-tuberculosis treatment will improve it by 6 month treatment. Increased diagnostic awareness and suspicion of this disease leads to timely diagnosis and appropriate treatment and prevents functional disorders.
التهاب غلاف تاندون / انگشتان / سل / مایکوباکتری سل
Fingers/ Mycobacterium Tuberculosis / Tenosynovitis / Tuberculosis
77
81
http://journal.gums.ac.ir/browse.php?a_code=A-10-1-503&slc_lang=fa&sid=1
T
Yaghubi Kalurazi
توفیق
یعقوبی کلورزی
0000-0002-6042-2331
No
Department of Infectious Diseases, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
S
Taramian
سنبل
طارمیان
0000-0002-5820-022X
Yes
Department of Infectious Diseases, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
گروه بیماریهای عفونی، دانشگاه علوم پزشکی گیلان، رشت، ایران
L
Mahfoozi
لیدا
محفوظی
0000-0002-1569-4346
No
Department of Infectious Diseases, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
گروه بیماریهای عفونی، دانشگاه علوم پزشکی گیلان، رشت، ایران
M
Khak
محمد
خاک
No
Department of Orthopedics, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
گروه ارتوپدی، دانشگاه علوم پزشکی گیلان، رشت، ایران