MYCOBACTERIUM CHELONAE HAND INFECTION: A REVIEW

Infectious Tenosynovitis of the Tibialis Anterior Due to Mycobacterium chelonae After Intravenous Heroin Injection

Mycobacterium chelonae is a ubiquitous Gram-positive, acid-fast, non-spore-forming bacterium commonly encountered in nature associated with aquatic animals, soil, and water, including tap water. Nontuberculous mycobacterial tenosynovitis infections caused by M. chelonae in the lower extremity are uncommon, leading to a paucity of literature documenting the diagnosis and treatment of such cases. This report is of a 65-year-old male patient who was found to have an M. chelonae infection along the tibialis anterior tendon after injecting himself with heroin into the dorsal foot veins. This review covers the diagnosis and treatment as well as a case report on the outcome of infectious tenosynovitis of the tibialis anterior associated with M. chelonae. To date, this is the only reported case of tibialis anterior infectious tenosynovitis caused by M. chelonae after intravenous heroin injection.

Non-tuberculosis Mycobacterium Tenosynovitis with Rice Bodies in a Patient with Systemic Lupus Erythematosus

Infectious disease with various presentations in systemic lupus erythematosus often resembles lupus flare. A 37-year-old woman presented with a swollen left index finger that had not resolved, despite 7 years of immunosuppressive treatment. MRI showed rice-body formation in the flexor tendon sheath and tenosynovectomy demonstrated chronic synovitis with epithelioid granuloma. A mycobacterial culture confirmed invasive mycobacterial tenosynovitis due to Mycobacterium chelonae. The patient was treated with moxifloxacin and clarithromycin and completely recovered.

Mycobacterial Infections in the Hand and Wrist

Mycobacterial hand infections are uncommon. These infections have an indolent course and are marked by variable and nonspecific presentations, often leading to diagnostic and treatment delays. The pathogens involved in mycobacterial hand infections include Mycobacterium tuberculosis complex, atypical mycobacteria, and M leprae. Initial treatment involves a combination of long-term antibiotics and surgical débridement to cure the infection. Reconstructive procedures aid in restoring hand function lost secondary to the disease.

Mycobacterium chelonae Wrist Infection in an Immunocompetent Patient

We report a 48-year-old Chinese immunocompetent female who presented with right wrist pain and swelling for 9 months because of Mycobacterium chelonae infection of her right wrist. M. chelonae infection has been increasingly reported. Immunocompromised patients are at increased risk of developing such an infection, however, this occasionally occurs in immunocompetent patients. M. chelonae infection more commonly causes cutaneous or soft tissue infection; however, in our case, we found that the infection was so severe that the infective tenosynovial tissue from the volar side of the wrist had eroded through both the volar and dorsal cortex of the distal radius. To our knowledge, wrist tenosynovitis with osteomyelitis of the distal radius caused by M. chelonae is rarely reported, especially in an immunocompetent nontraumatic individual. We successfully treated this patient by repeated surgical debridement using different approaches, appropriate antibiotics, as well as application of antibiotic-loaded cement to fill the bone defect.

Rapid development of sarcoid tenosynovitis

We report a case of acute tenosynovitis from sarcoidosis and review previously reported cases of this entity. A woman with known pulmonary sarcoidosis rapidly developed painless nodules in the tendon sheaths of the dorsum of both hands and wrists. Sarcoid tenosynovitis is almost exclusively found in the upper extremity. The flexor and extensor tendons are equally affected. The condition may respond to medical therapy including corticosteroids and other immunomodulating medications. Surgical debulking and tendon sheathectomy have also been curative. The disease has also been reported to spontaneously resolve. Our patient dramatically improved while on methotrexate.