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Case Reports
. 2021 Spring;21(1):86-89.
doi: 10.31486/toj.19.0010.

Recurrent Nontuberculous Mycobacterial Tenosynovitis

Melissa Kwan  1 , Richard Tupler  1
Affiliations
Case Reports

Recurrent Nontuberculous Mycobacterial Tenosynovitis

Melissa Kwan et al. Ochsner J. 2021 Spring.

Abstract

Background: Nontuberculous mycobacteria are an uncommon pathogen for musculoskeletal infection and are difficult to treat because of delays in diagnosis, prolonged treatment requiring both antimycobacterial therapy and surgical debridement, and high rates of resistance to antimycobacterial therapy. Case Report: We report the case of an 88-year-old male with recurrent Mycobacterium avium complex tenosynovitis despite receiving multiple courses of pharmacologic therapy and surgical debridement. Conclusion: Nontuberculous mycobacterial musculoskeletal infections can be difficult to diagnose and equally difficult to treat. A combination of antimycobacterial therapy and surgical debridement is often required; however, the rate of treatment failure remains high, particularly with rapidly growing mycobacteria such as Mycobacterium avium.

Keywords: Arthritis–infectious; Mycobacterium avium complex; Mycobacterium infections–nontuberculous; osteomyelitis; tenosynovitis.

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Figures

Figure 1.
Figure 1.
Initial magnetic resonance imaging examination with (A) coronal T1, (B) coronal short T1 inversion recovery (STIR), and (C) axial T2 fat saturation sequences. View A shows no evidence of osseous erosions or marrow-replacing process to suggest osteomyelitis. Views B and C show fluid within the carpal tunnel and associated innumerable low T2 foci, presumed rice bodies (white arrows).
Figure 2.
Figure 2.
Most recent magnetic resonance imaging examination at the carpal level with (A) coronal T1 and (B) coronal postcontrast T1 fat saturation sequences with inclusion of the metacarpals on (C) coronal T1, (D) coronal short T1 inversion recovery (STIR), and (E) coronal post-contrast T1 fat saturation sequences. Views A and B show joint space narrowing, osseous erosions (asterisks), and synovial enhancement (asterisks) throughout the carpals. Dashed white arrows show marrow edema (views C and D) and enhancement (view E) of the second metacarpal concerning for osseous involvement of the adjacent infectious process within the carpals. Additionally, complex enhancing fluid is seen at the distal radioulnar joint (solid arrows in views D and E).
See this image and copyright information in PMC

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