The Clinical Picture

Unraveling a challenging diagnosis: Role of a TNF inhibitor

Soumya Chatterjee, MD, MS, FRCP, FACP, FACR
Cleveland Clinic Journal of Medicine July 2022, 89 (7) 368-370; DOI: https://doi.org/10.3949/ccjm.89a.21128

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Swelling of the dorsum of the right hand, with limited mobility of the right wrist and flexion of the fourth finger. The inflammation had begun as a red nodule on the dorsum of the second metacarpophalangeal joint (A) and slowly progressed to a soft, doughy-looking, subcutaneous mass encompassing the dorsum of the right hand (B).

  • Figure 2
    Figure 2

    During tenosynovectomy, rice bodies were extruded through the surgical incision. Histologic study revealed noncaseating granulomatous inflammation with multinucleated giant cells.

  • Figure 3
    Figure 3

    The patient required surgical repair of a ruptured extensor tendon (arrow) of the right middle finger.

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