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Oka K, Morioka H, Eguchi M, Sato Y, Tetsuka N, Iguchi M, Kanematsu T, Fukano H, Hoshino Y, Kiyoi H, Yagi T. Bursitis, Bacteremia, and Disseminated Infection of Mycobacteroides (Mycobacterium) abscessus subsp. massiliense. Intern Med 2021; 60:3041-3045. [PMID: 33775997 PMCID: PMC8502645 DOI: 10.2169/internalmedicine.6189-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a 59-year-old woman with a 2-year history of chronic bursitis of the hand who took 50 mg/day prednisolone for several autoimmune diseases. Mycobacteroides abscessus subsp. massiliense was isolated from the abscess and blood culture. Combination therapy (imipenem/cilastatin, amikacin, and clarithromycin) was administered for a month. Two months later, M. massiliense was detected from a blood culture again, and disseminated lesions were found. Clarithromycin and sitafloxacin were administered following eight weeks of the same regimen. Six months after the diagnosis, M. massiliense was isolated from a blood culture, and she expired due to multiple organ failure.
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Affiliation(s)
- Keisuke Oka
- Department of Infectious Diseases, Nagoya University Hospital, Japan
| | - Hiroshi Morioka
- Department of Infectious Diseases, Nagoya University Hospital, Japan
| | - Motoki Eguchi
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Japan
| | - Yoshitaka Sato
- Department of Infectious Diseases, Nagoya University Hospital, Japan
- Department of Virology, Nagoya University Graduate School of Medicine, Japan
| | - Nobuyuki Tetsuka
- Department of Infectious Diseases, Nagoya University Hospital, Japan
| | - Mitsutaka Iguchi
- Department of Infectious Diseases, Nagoya University Hospital, Japan
| | - Takeshi Kanematsu
- Department of Clinical Laboratory, Nagoya University Hospital, Japan
| | - Hanako Fukano
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Japan
| | - Yoshihiko Hoshino
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Japan
| | - Hitoshi Kiyoi
- Department of Hematology, Nagoya University Hospital, Japan
| | - Tetsuya Yagi
- Department of Infectious Diseases, Nagoya University Hospital, Japan
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Olecranon bursitis secondary to Mycobacterium europaeum infection in a patient receiving immunosuppressive drugs for rheumatoid arthritis. Med Mal Infect 2019; 49:358-359. [PMID: 31097371 DOI: 10.1016/j.medmal.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 10/08/2018] [Accepted: 03/04/2019] [Indexed: 11/20/2022]
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Kim DH, Min S, Lee HJ, Kim HJ, Lee H, Yoon JP. Synchronization of Synovial Chondromatosis and Mycobacterium intracellurae Infection in Olecranon Bursitis: A Case Report. Clin Shoulder Elb 2019; 22:46-49. [PMID: 33330194 PMCID: PMC7713878 DOI: 10.5397/cise.2019.22.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/26/2022] Open
Abstract
A 73-year-old woman presented with a recurrent cystic mass around her left olecranon. She had a history of 8 steroid injections due to elbow pain beginning 3 years ago and twice had undergone aspiration of olecranon bursitis that developed two months prior to presentation. She had been taking medications for hypertension and diabetes with no pertinent past history. On magnetic resonance imaging (MRI), there were multiple nodules in the olecranon bursa, which were isointense to muscle on T1-weighted images and hyperintense to muscle on T2-weighted images. Our initial diagnosis was synovial chondromatosis. On bursoscopy, masses of gray-white colored nodules were observed in the bursa. Finally, synovial chondromatosis and non-tuberculous mycobacterial infection were concurrently diagnosed. In conclusion, uncalcified synovial chondromatosis and rice bodies can have similar visual and MRI characteristics; therefore, we suggest that clinicians should be aware of the possibility of other infections in cases of this type.
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Affiliation(s)
- Dong Hyun Kim
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seunggi Min
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyun Joo Lee
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hee-June Kim
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hoseok Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
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Ruangchaijatuporn T, Chang EY, Chung CB. Solitary subcutaneous sarcoidosis with massive chronic prepatellar bursal involvement. Skeletal Radiol 2016; 45:1741-1745. [PMID: 27709260 DOI: 10.1007/s00256-016-2494-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/29/2016] [Accepted: 09/19/2016] [Indexed: 02/02/2023]
Abstract
A 56-year-old man presented with a painless prepatellar mass of the left knee. MR images demonstrated a large, well-defined mass with heterogeneous intermediate signal intensity on T1- and proton density-weighted images. Mild, heterogeneous enhancement was noted after the intravenous administration of gadolinium. Diagnostic imaging included atypical soft-tissue infection, fibrogranulomatous reaction, gouty tophus, rheumatoid nodule and xanthoma or possibly malignancy. The histopathological examination revealed sarcoidosis involving the prepatellar bursa.
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Affiliation(s)
- Thumanoon Ruangchaijatuporn
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rachathewi, Bangkok, Thailand, 10400.
| | - Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, 92161, USA.,Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, 92103, USA
| | - Christine B Chung
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, 92161, USA.,Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, 92103, USA
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Konrads C, Rückl K, El Tabbakh M, Rudert M, Kircher S, Plumhoff P. Therapy-resistant septic olecranon bursitis due to Mycobacterium gordonae. SICOT J 2016; 2:41. [PMID: 27892398 PMCID: PMC5125158 DOI: 10.1051/sicotj/2016030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/04/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction: Septic olecranon bursitis due to atypical mycobacteria is rare. An insidious beginning can delay diagnosis and treatment. Antibacterial therapy recommendations are not well-defined for bursitis caused by atypical mycobacteria. We present a rare case of olecranon bursitis caused by Mycobacterium gordonae, reporting our experiences regarding pathogen identification and antibiotic therapy, which differs from regimes used in common septic bursitis mostly caused by staphylococcus aureus. Methods: A 35-year-old male with bursitis olecrani received open bursectomy. Microbiological culture did not reveal bacteria. Due to wound healing complications revision surgery was performed four weeks postoperatively. Finally, Mycobacterium gordonae was identified by PCR and an antibiogram could be developed. A triple antimicrobial combination therapy with Rifampicin, Clarithromycin, and Ethambutol was administered systemically for 12 months. The patient was followed-up for 24 months. Results: After the second operation with pathogen identification and antibiotic combination therapy the wound healed without any additional complications. At last follow-up 24 months after the first surgery with bursectomy and 23 months after revision surgery with debridement, the patient was still pain free with no significant clinical findings or tenderness to touch at the operation site. Elbow range of motion was full. Discussion: As septic bursitis can be caused by many different and sometimes rare and difficult to identify bacteria, intraoperative probes should be taken and histopathological and microbiological analysis should be conducted, including PCR. In a young man with olecranon bursitis due to Mycobacterium gordonae surgical treatment and an antibiotic combination therapy showed a good clinical outcome after one and two years.
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Affiliation(s)
- Christian Konrads
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Brettreichstr. 11, 97074 Würzburg, Germany
| | - Kilian Rückl
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Brettreichstr. 11, 97074 Würzburg, Germany
| | - Mohammed El Tabbakh
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Brettreichstr. 11, 97074 Würzburg, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Brettreichstr. 11, 97074 Würzburg, Germany
| | - Stefan Kircher
- Institute of Pathology, University of Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Piet Plumhoff
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Brettreichstr. 11, 97074 Würzburg, Germany
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Tan EM, Marcelin JR, Mason E, Virk A. Mycobacterium avium intracellulare complex causing olecranon bursitis and prosthetic joint infection in an immunocompromised host. J Clin Tuberc Other Mycobact Dis 2015; 2:1-4. [PMID: 31723678 PMCID: PMC6850247 DOI: 10.1016/j.jctube.2015.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/10/2015] [Accepted: 11/25/2015] [Indexed: 01/25/2023] Open
Abstract
Case A 73-year-old immunocompromised male presented with recurrent left elbow swelling due to Mycobacterium avium intracellulare complex (MAC) olecranon bursitis. 3 years after completing MAC treatment, he underwent right total knee arthroplasty (TKA). 1 year later, he developed TKA pain and swelling and was diagnosed with MAC prosthetic joint infection (PJI). He underwent TKA resection, reimplantation, and 12 months of anti-MAC therapy. This patient is the seventh case report of MAC olecranon bursitis and the third case report of MAC PJI. He is the only report of both MAC olecranon bursitis and PJI occurring in the same patient. Informed consent This patient was informed and agreed to the publication of this material.
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Affiliation(s)
- Eugene M Tan
- Department of Medicine, Mayo Clinic, 200 First Street SW Rochester, MN 55905, USA
| | - Jasmine R Marcelin
- Division of Infectious Diseases, Mayo Clinic, 200 First Street, SW Rochester, MN 55905, USA
| | - Erin Mason
- Division of Infectious Diseases, Mayo Clinic, 200 First Street, SW Rochester, MN 55905, USA
| | - Abinash Virk
- Division of Infectious Diseases, Mayo Clinic, 200 First Street, SW Rochester, MN 55905, USA
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Mycobacterium avium complex olecranon bursitis resolves without antimicrobials or surgical intervention: A case report and review of the literature. IDCases 2015; 2:59-62. [PMID: 26793457 PMCID: PMC4672609 DOI: 10.1016/j.idcr.2015.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 04/02/2015] [Accepted: 04/05/2015] [Indexed: 11/29/2022] Open
Abstract
Introduction Nontuberculous mycobacteria are an uncommon cause of septic olecranon bursitis, though cases have increasingly been described in both immunocompromised and immunocompetent hosts. Guidelines recommend a combination of surgical resection and antimicrobials for treatment. This case is the first reported case of nontuberculous mycobacterial olecranon bursitis that resolved without medical or surgical intervention. Case presentation A 67-year-old female developed a painless, fluctuant swelling of the olecranon bursa following blunt trauma to the elbow. Due to persistent bursal swelling, she underwent three separate therapeutic bursal aspirations, two involving intrabursal steroid injection. After the third aspiration, the bursa became erythematous and severely swollen, and bursal fluid grew Mycobacterium avium complex. Triple-drug antimycobacterial therapy was initiated, but discontinued abruptly due to a rash. Surgery was not performed. The patient was observed off antimicrobials, and gradually clinically improved with a compressive dressing. By 14 months after initial presentation, clinical exam revealed complete resolution of the previously erythematous bursal mass. Discussion This is the first reported case of nontuberculous mycobacterial olecranon bursitis managed successfully without surgery or antimicrobials. Musculoskeletal nontuberculous mycobacterial infections are challenging given the lack of clinical data about optimal duration and choice of antimicrobials or the role of surgery. Additionally, the potential toxicity and drug interactions of antimycobacterials are not insignificant and warrant close monitoring if treatment is pursued. Conclusion This case raises an important clinical question of whether close observation off antimicrobials is appropriate in select cases of immunocompetent patients with localized atypical mycobacterial disease of soft tissue and skeletal structures.
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Viehman JA, Khalil D, Barhoma C, Hanna RM. Mycobacterium avium-intracellulare otomastoiditis in a young AIDS patient: case report and review of the literature. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2013; 5:61-6. [PMID: 23459156 PMCID: PMC3583439 DOI: 10.2147/hiv.s36545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Mycobacterium avium-intracellulare (MAI) complex is a common opportunistic infection that generally occurs in patients with a CD4 cell count less than 75. Current recommendations for prophylaxis include using a macrolide once a week, while treatment usually requires a multidrug regimen. Disseminated MAI infections often occur in patients who are not compliant with prophylaxis or their highly active antiretroviral therapy (HAART). Many manifestations of MAI infection are well documented in human immunodeficiency virus (HIV) patients, including pulmonary and cutaneous manifestations, but other unusual manifestations such as pericarditis, pleurisy, peritonitis, brain abscess, otitis media, and mastoiditis are sporadically reported in the infectious diseases literature. This case report is of a 22-year-old female who contracted HIV at a young age and who was subsequently noncompliant with HAART, MAI prophylaxis, and prior treatment for disseminated MAI infection. Unsurprisingly, the patient developed recurrent disseminated MAI infection. The patient’s presentation was atypical, as she developed severe otomastoiditis and posterior reversible encephalopathy syndrome. The posterior reversible encephalopathy syndrome was thought to be due to the disseminated MAI infection or to immune reconstitution inflammatory syndrome. The infection was confirmed to be secondary to MAI by culture of the mastoid bone. Microbiological analysis of the MAI strain cultured showed resistance to several first-line antibiotics used for prophylaxis against and treatment of MAI. This was likely due to the patient’s chronic noncompliance. Otomastoiditis secondary to MAI is extremely rare in adults and has been reported in only four case reports and one case series previously. Improved clinician education in the diagnosis, treatment, and, most important, prevention of MAI and other opportunistic infections is needed. Greater HIV screening, appropriate HAART medication administration, and availability of infectious disease specialists is needed in at-risk populations to help prevent such serious infections. Patient education and greater access to care should serve to prevent medication nonadherence and to enhance affordability of HAART and prophylactic antibiotics.
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Affiliation(s)
- J Alexander Viehman
- Department of Medicine, Olive View-UCLA Medical Center, Los Angeles ; David Geffen School of Medicine at UCLA, Los Angeles
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Goyal T, Nag HL, Tripathy SK. Giant subdeltoid tubercular bursitis: a case report. Orthop Surg 2012; 4:269-72. [PMID: 23109315 PMCID: PMC6583150 DOI: 10.1111/os.12012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Tarun Goyal
- Department of OrthopaedicsVictoria InfirmaryGlasgowUK
| | - Hira L Nag
- Department of OrthopaedicsAll India Institute of Medical SciencesNew DelhiIndia
| | - Sujit K Tripathy
- Department of OrthopaedicsSouth Tees Hospital NHS Foundation TrustMiddlesboroughUK
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