PMC9127846_01
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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Laboratory tests and vital signs were obtained, as shown in Figure 1.
Initial right wrist anteroposterior (AP) radiograph demonstrating significant osteopenia and degenerative changes across the joints of the wrist and carpus.
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The emergency department provider obtained radiographs of the right wrist (Figure 2).
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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It was erythematous and had developed desquamation of the skin around the lesion (Figure 3).
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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A magnetic resonance image (MRI) with intravenous (IV) contrast was obtained to further characterize the lesion and its involvement (Figure 4).
Surgical pathology (a) and (b), demonstrating caseating granulomas.
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Following the first I&D, the whole blood QuantiFERON TB gold test returned as positive and preliminary pathology showed for caseating granulomas (Figure 5).
Clinical photograph of soft tissue defect (measuring approximately 2 cm x 6 cm) following final irrigation and debridement.
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The large volar fluctuance had created a sizable soft tissue defect that was not amenable to primary closure (Figure 6).
Two-month follow-up radiographs demonstrating diffuse osteopenia about right wrist and hand with advanced degenerative changes.
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RIPE therapy. Radiographs obtained from that follow-up appointment demonstrated severe degeneration of the right wrist and carpus with continued osteopenia (Figure 7).