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Malisetyan T, Harmon SR, Reyes M, Shoja MM, Schwartz G. Nontuberculous Mycobacterial Flexor Tenosynovitis of the Wrist and Hand. Cureus 2024; 16:e58716. [PMID: 38779290 PMCID: PMC11110490 DOI: 10.7759/cureus.58716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Nontuberculous mycobacteria (NTM) are uncommon causes of cutaneous and musculoskeletal infections. Here, we present an immunocompromised patient with persistent swelling in the left hand, wrist, and distal forearm. MRI findings revealed flexor tenosynovitis with synovial hypertrophy of the left hand and wrist and loculated fluid containing rice bodies along the distal flexor digitorum muscles in the volar aspect of the left wrist. The patient underwent flexor tenosynovectomy, and histological examination of the excised tenosynovium and mass revealed noncaseating granulomas. Mycobacterium intracellulare was identified in microbiological cultures. Antimycobacterial therapy was administered postoperatively to manage the infection. This report underscores the significance of maintaining a high index of suspicion for NTM infection when assessing chronic hand swelling, particularly in individuals with compromised immune systems.
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Affiliation(s)
- Tatevik Malisetyan
- Department of Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Skylar R Harmon
- Department of Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Mariafe Reyes
- Department of Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Mohammadali M Shoja
- Department of Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Gary Schwartz
- Department of Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
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Vietor FI, Nelson TB. Difficulty in Diagnosis and Management of Musculoskeletal Nontuberculous Mycobacterial Infections. IDCases 2022; 29:e01527. [PMID: 35706608 PMCID: PMC9189991 DOI: 10.1016/j.idcr.2022.e01527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/04/2022] [Indexed: 11/29/2022] Open
Abstract
We describe two cases of musculoskeletal nontuberculous mycobacterial (NTM) infection resulting in undesirable outcomes. These organisms can be difficult to identify and treat, potentially leading to significant morbidity. NTM should remain on the differential for culture negative bone and joint infections, especially with a prior surgical history or environmentally-acquired injuries. There is considerable difficulty in diagnosing NTM orthopedic infections. These infections can be prolonged and progressive. Consider NTM infection with negative cultures and failure of routine antibacterials. Surgical debridement is essential in combination with antimycobacterials. Treatment should be determined after culture results yield drug susceptibilities.
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Affiliation(s)
- Faith I. Vietor
- University of Missouri-Columbia School of Medicine, 1 Hospital Drive, Columbia, MO 65212, USA
- Corresponding authors.
| | - Taylor B. Nelson
- Division of Infectious Diseases, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA
- Corresponding authors.
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Ma Q, Chen R, Yang E, Yuan Y, Tian Y, Han Y, Wang S, Wang B, Yan W, Zhang Q, Jing N, Ma B, Wang Z, Li Y, Li Y. Non-tuberculous Mycobacterial Infection of the Musculoskeletal System Detected at Two Tertiary Medical Centres in Henan, China, 2016-2020. Front Microbiol 2021; 12:791918. [PMID: 34975815 PMCID: PMC8718100 DOI: 10.3389/fmicb.2021.791918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/18/2021] [Indexed: 01/15/2023] Open
Abstract
Non-tuberculous mycobacterial (NTM) infection of the musculoskeletal system is rare but poses a grave threat to public health. These infections yield non-specific symptoms that remain undetected until the development of the later stages of the disease. In this study, we performed a retrospective review of 25 cases of musculoskeletal NTM infection at two tertiary medical centres over a 5-year period to determine the clinical features and improve the current clinical diagnosis and treatment. The most common mycobacterial species detected were Mycobacterium fortuitum in eleven patients, Mycobacterium abscessus in eight patients, Mycobacterium houstonense in three patients, Mycobacterium avium in two patients, and Mycobacterium smegmatis in one patient. The sites of infection included the limbs and joints, most commonly the knee (ten patients) and foot (six patients). The median duration from the onset of symptoms to diagnosis was 2.5 months (0.8-13.5 months). Deep sinus tracts extending to the surgical site were observed in 60% of the patients (15/25), and granulomatous inflammation and granulomatous inflammation with necrosis occurred in 60% of the patients (15/25). All patients underwent surgical treatment for infection control, and all patients, except one, received antimycobacterial therapy based on drug sensitivity assays. The median duration of the antimicrobial chemotherapy was 5 months (range: 3-20 months). At the final follow-up, 24 patients presented with absence of recurrence and one patient succumbed owing to heart failure after debridement. Our findings highlight the importance of vigilance and improvements in the diagnostic methods for musculoskeletal NTM infection. Aggressive surgical treatment and antimycobacterial drug treatment can help achieve satisfactory results.
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Affiliation(s)
- Qiong Ma
- Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Henan University People’s Hospital, Zhengzhou, China
| | - Rende Chen
- Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, China
| | - Enhui Yang
- Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Henan University People’s Hospital, Zhengzhou, China
| | - Youhua Yuan
- Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Henan University People’s Hospital, Zhengzhou, China
| | - Yongfu Tian
- Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, China
| | - Yongguang Han
- School of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, China
| | - Shanmei Wang
- Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Henan University People’s Hospital, Zhengzhou, China
| | - Baoya Wang
- Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Henan University People’s Hospital, Zhengzhou, China
| | - Wenjuan Yan
- Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Henan University People’s Hospital, Zhengzhou, China
| | - Qi Zhang
- Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Henan University People’s Hospital, Zhengzhou, China
| | - Nan Jing
- Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Henan University People’s Hospital, Zhengzhou, China
| | - Bing Ma
- Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Henan University People’s Hospital, Zhengzhou, China
| | - Zhen Wang
- Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Henan University People’s Hospital, Zhengzhou, China
| | - Yi Li
- Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Henan University People’s Hospital, Zhengzhou, China
| | - Yongjun Li
- Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, China
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Patel J, Guzman N, Wukitsch K. Atypical Mycobacterial Tenosynovitis in the Setting of Adalimumab Use. Cureus 2021; 13:e18952. [PMID: 34812325 PMCID: PMC8604424 DOI: 10.7759/cureus.18952] [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] [Accepted: 10/20/2021] [Indexed: 11/05/2022] Open
Abstract
Tumor necrosis factor-alpha (TNF-α) inhibitors indicated in the management of psoriasis, rheumatoid arthritis, ulcerative colitis, Crohn's disease, and other autoimmune diseases have been associated with the development of mycobacterial and other opportunistic infections. The majority of mycobacterial infections diagnosed in patients taking TNF-α inhibitors are secondary to Mycobacterium tuberculosis. Atypical mycobacteria have also been identified in this patient population, most commonly manifested by pulmonary or disseminated infections. Extra-pulmonary manifestations such as bone and joint infections are rare. We describe a case of atypical mycobacterial tenosynovitis in the setting of adalimumab use in a patient with psoriasis. This is a rarely reported complication that one should be aware of when prescribing these medications.
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Affiliation(s)
- Jay Patel
- Internal Medicine, Orange Park Medical Center, Orange Park, USA
| | - Nilmarie Guzman
- Internal Medicine, Orange Park Medical Center, Orange Park, USA
| | - Kurt Wukitsch
- Internal Medicine, Orange Park Medical Center, Orange Park, USA
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