Abstract
We carefully read the letter of Gokkus et. al. regarding our article and the article they declared to have been published before [1]. We thank them for their interest in our article and would like to clarify some situations.
Caseous granuloma can be seen in typical tuberculosis infection of the tenosynovium. However, rice body, fibrinous masses, and thickened synovitis may not be seen in atypical infections [2].
In a series of 70 cases, Sant et al found synovial membrane proliferation in 92.8%, mast cell increase in 82.9%, and caseification in 78.5% of all cases [3].
Therefore, although there is a small rate, there is a tuberculous tenosynovitis case group in which histopathological examination is completely normal. We think that intraoperative clinical approach is particularly important for this situation. In the presented case, the hand surgeon who performed the operation had to make a diagnosis of tuberculous tenosynovitis after seeing the rice body formations.
Therefore, if the sample to be taken intraoperatively is subjected to histopathological examination only, there may be some patients that will be overlooked - even if a little.
There was no alcohol or drug abuse in the presented case. He did not have any known diseases that suppressed immunity. His socioeconomic status was not low, he was not malnourished, and his body mass index was within normal limits. In other words, the only thing that would suspect tuberculosis was intraoperative findings.
Therefore, it is thought that physicians dealing with hand surgery in countries where tuberculosis infection continues to be seen should have knowledge and experience in this regard. In this way, when thickened synovium and rice body formations are seen, samples should be taken not only for histopathological examination but also for culture, acid-resistant staining, and tuberculosis DNA tests.