The possibility of infection with mycobacterium tuberculosis (TB) and other infectious agents is the first option when granulomatous inflammation has been observed in the histological examination of a tissue specimen. However, gout with manifestations of granulomatous synovitis may mimic TB tenosynovitis.
An 80-year-old male with a history of hypertension and gout presented with the swelling of the right wrist and deformity as a result of trauma. The results of Cytology for malignancy, TB polymerase chain reaction (PCR) and TB culture were negative. Histopathological examination with an electron microscope confirmed the diagnosis of tophaceous gout along with granulomatous synovitis.
The present case highlights the importance of accurate diagnosis of a gouty process in patients who manifest granulomatous tophaceous-like tuberculous tenosynovitis or rheumatoid arthritis. We suggested that gout should be considered in the differential diagnosis of granulomatous synovitis, especially in cases with negative mycobacterium TB-PCR.