Clinical Case of the Month. A 44-Year-Old HIV-Infected Man With Righ-Shoulder Swelling

Area of Science:

• Infectious Diseases
• Rheumatology
• Microbiology

Background:

• Immunocompromised individuals are at increased risk for opportunistic infections, including atypical mycobacterial joint infections.
• Early and accurate diagnosis of joint infections is crucial for effective management and preventing long-term sequelae.
• Mycobacterium kansasii is an environmental mycobacterium that can cause opportunistic infections, particularly in patients with human immunodeficiency virus (HIV).

Observation:

• A case of chronic effusion arthropathy of the right shoulder in a human immunodeficiency virus (HIV)-infected patient is presented.
• The patient's chronic shoulder effusion was found to be caused by Mycobacterium kansasii, an unusual pathogen for this presentation.
• This case underscores the importance of considering less common pathogens in the differential diagnosis of arthropathy in immunocompromised patients.

Findings:

• Mycobacterium kansasii can present as a chronic effusion arthropathy, even in the absence of typical signs of disseminated infection.
• Diagnostic joint aspiration is essential for identifying the causative pathogen and guiding appropriate antimicrobial therapy.
• Review of risk factors, transmission, clinical manifestations, and management of Mycobacterium kansasii infections is provided.

Implications:

• Physicians should maintain a high index of suspicion for mycobacterial joint infections in immunocompromised patients with unexplained arthropathy.
• Prompt identification and treatment of Mycobacterium kansasii are vital to prevent joint destruction and systemic complications.
• This case contributes to the understanding of atypical presentations of mycobacterial infections in the context of HIV and immunocompromise.