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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
Soumya Chatterjee
Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Rheumatology Fellowship Program Director, Staff, Department of Rheumatic and Immunologic Diseases, Orthopaedic and Rheumatology Institute, Cleveland Clinic, Cleveland, OH
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    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).

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    Figure 2

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

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    Figure 3

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

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Cleveland Clinic Journal of Medicine: 89 (7)
Cleveland Clinic Journal of Medicine
Vol. 89, Issue 7
1 Jul 2022
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Unraveling a challenging diagnosis: Role of a TNF inhibitor
Soumya Chatterjee
Cleveland Clinic Journal of Medicine Jul 2022, 89 (7) 368-370; DOI: 10.3949/ccjm.89a.21128

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Unraveling a challenging diagnosis: Role of a TNF inhibitor
Soumya Chatterjee
Cleveland Clinic Journal of Medicine Jul 2022, 89 (7) 368-370; DOI: 10.3949/ccjm.89a.21128
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  • Article
    • FEATURES OF M MARINUM INFECTION
    • WHEN TO SUSPECT M MARINUM INFECTION
    • TREATMENT CHALLENGES
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