Management of atypical Mycobacterium szulgai digital flexor tenosynovitis

Mycobacterium szulgai is a rare, atypical pathogen predominantly associated with pulmonary infections but capable of causing suppurative tenosynovitis-a potentially devastating infection of the tendon sheath. This case involves a patient presenting with insidious pain and swelling of the right index finger. After multiple consultations, the patient was indicated for surgical exploration which revealed significant flexor tendon sheath tenosynovitis and inflammation with subsequent cultures growing M. szulgai The patient was treated with a broad-spectrum antibiotic regimen, adjusted postoperatively based on culture results. Significant improvements in finger mobility and swelling reduction were observed by the 6-week follow-up. This case emphasises the necessity of comprehensive diagnostic evaluation and precise antimicrobial therapy in managing rare mycobacterial infections, contributing valuable insights to the limited literature on non-tuberculous mycobacterial tenosynovitis.