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Mycobacterium Immunogenum Flexor Tenosynovitis: A Case Report.
Jomar N A Aryee1, Sheriff D Akinleye2, Aaron M Freilich2
1Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Journal of Wrist Surgery
|June 10, 2021
Summary
Nontuberculous mycobacterial (NTM) flexor tenosynovitis is rare but serious. This case highlights Mycobacterium immunogenum as a cause, emphasizing complex treatment needs for this challenging infection.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Nontuberculous mycobacterial (NTM) infections are uncommon but can cause severe upper extremity issues.
- Flexor tenosynovitis due to NTM is a rare clinical presentation.
- Mycobacterium immunogenum is a recently characterized pathogen.
Observation:
- A patient presented with insidious swelling and pain in the upper extremity.
- The condition required multiple surgical debridements.
- Diagnosis was complicated by nonspecific symptoms and challenging laboratory identification.
Findings:
- Mycobacterium immunogenum was identified as the causative agent of flexor tenosynovitis.
- The infection proved recalcitrant, necessitating a complex antimicrobial regimen.
- Treatment involved empiric macrolide sensitivity followed by tailored therapy.
Implications:
- This is the first reported case of Mycobacterium immunogenum causing musculoskeletal infection.
- Management of NTM tenosynovitis, especially by M. immunogenum, is difficult.
- Multispecialty collaboration between orthopedics and infectious diseases is crucial for effective treatment.
