Extra-articular tenosynovial chondromatosis of the right fifth digit in a 59-year-old man: A case report and literature review.

Tenosynovial chondromatosis is a rare benign disorder characterized by formation of cartilaginous bodies within the synovia of the tendon sheaths. Most commonly present in the hands and feet. Clinical presentation and plain radiography can be inconclusive, which can lead to misclassification, most often confused as a chondroma of soft parts. In this case, we report the clinical, radiologic, and histology of a 59-year-old man who presented with a 1-year history of mass on the right fifth digit with limitation of motion secondary to this condition. Surgical excision revealed multiple cartilaginous nodules of varying size arising from the flexor tendon sheath. The diagnosis was confirmed postoperatively by surgical histopathology. The postoperative course of the patient was uncomplicated and has achieved an excellent functional recovery.

Case 209: Disseminated coccidioidal spondylodiskitis.

History A 46-year-old Hispanic man with a medical history of diabetes and hepatitis C and an unclear history of prior infectious disease presented to the emergency department of a community medical center in the northeastern United States with a 3-month history of back pain. The patient was originally from Mexico and had been living in the United States for approximately 1 year. Physical examination at the time of admission was noncontributory. Pertinent hematologic laboratory test results were as follows: white blood cell count, 11.2 ×10(9)/L (normal range, [4.5-11.0] ×10(9)/L); neutrophil level, 81.3% (0.81) (normal range, 38.9%-75.1% [0.39-0.75]); hemoglobin level, 7.9 g/dL (normal range, 13.5-18.0 g/dL); hematocrit level, 23.2% (0.23) (normal range, 40.0%-54.0% [0.40-0.54]); and calcium level, 8.3 mg/dL (2.07 mmol/L) (normal range, 8.4-10.4 mg/dL [2.1-2.6 mmol/L]). Protein electrophoresis revealed hypergammaglobulinemia consistent with chronic inflammation. Relevant radiologic studies included computed tomography (CT) and magnetic resonance (MR) imaging of the spine.