Extensor Tenosynovitis due to Mycobacterium marseillense Infection in a Renal Transplant Recipient

Abstract

Renal transplant recipients are at an increased risk of atypical nontuberculous mycobacterial (NTM) infections. Infections caused by NTM are uncommon in the general population, rarely occurring in immunocompetent individuals. NTM infections are an uncommon cause of tenosynovitis. Mycobacterium marseillense is a rare, atypical mycobacteria that has been reported to cause pulmonary and cutaneous infections; however, no previous reports of this pathogen causing tenosynovitis exist. This case reports a 73-year-old male renal transplant recipient who presented with chronic extensor tenosynovitis of the right hand caused by M marseillense. The patient was treated with radical extensor tenosynovectomy and 6 months of antibiotic treatment. A review of literature on tenosynovitis caused by atypical mycobacteria was performed. The patient successfully responded to treatment with no complications or recurrence of infection at the 18-month follow-up. Tenosynovitis of the hand caused by atypical mycobacteria is rare. A high index of suspicion is required to prevent a delay in diagnosis, particularly in immunocompromised individuals.

Figure 1

T2-weighted axial MRI of the right wrist demonstrate innumerable rice bodies within the fourth dorsal compartment with distension of the tendon sheath and a partial rupture of the extensor digitorum communis.

Figure 2

Photograph showing the dorsal (A) and lateral (B) aspects of the right wrist 3 months after radical extensor tenosynovectomy.