PMC5491825_01
The left wrist is markedly swollen.
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A musculoskeletal examination revealed marked swelling on both the dorsal and palmar surfaces of the left wrist (Fig. 1) and tenderness in both wrists.
(a) Transverse musculoskeletal ultrasonography of the third and fourth compartments of the left wrist. The grayscale image shows a markedly thickened extensor tendon sheath, and power Doppler signals are detected in the margin of the tendon sheath. (b) The longitudinal view of the extensor tendon sheath. Multiple isoechoic rice bodies surround the tendon (white asterisk).
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In addition, marked power Doppler signals were detected in the margin of the tendon sheath (Fig. 2a). The tenosynovium was filled with rice bodies (Fig. 2b).
(a) The operative findings show a markedly thickened extensor tendon sheath. (b) Hematoxylin and Eosin staining of the tenosynovium shows chronic inflammatory tissue with plasma cell and lymphocyte infiltration. Original magnification x20.
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Macroscopically, the extensor and flexor tendon sheaths were markedly thickened (Fig. 3a). A histopathological examination of the resected tenosynovium revealed granulomatous tissue accompanied by plasma cell and lymphocyte infiltrations (Fig. 3b).
Grocott's methenamine silver staining shows oval-shaped yeasts. Original magnification x1,000.
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However, Grocott's methenamine silver (GMS) stain detected a small number of oval-shaped yeasts (Fig. 4).