Granulomatous Tenosynovitis of the Volar Wrist from Mycobacterium Avium Complex - A Case Report

Mycobacterium avium complex (MAC) musculoskeletal (MSK) involvement is a rare clinical presentation of the upper extremity. When MSK involvement does occur, hand and wrist involvement are the most often reported due to the rich synovial fluid environment in these regions. This report describes an unusual case of tenosynovitis of the hand, in which a patient presented with a prolonged course of wrist pain due to MAC.

An 87-year-old Caucasian, right-handed female presented with a 2-year history of right wrist pain and swelling. There had been no previous trauma or immunocompromised state. The patient was hospitalized for severe pneumonia 2 years ago, with wrist pain developing in the months after discharge. The treatment course included radical synovectomy and subsequent triple antibiotic therapy upon confirmation of MAC rice bodies. Due to advanced age and worsening dementia, the patient did not follow-up until 2 years post-operatively. Upon return at 2 years postoperatively, the patient had concerns of recurrent tenosynovitis. Treatment was declined by the family at this time and the patient did not return again until 5 years postoperatively with continued worsening tenosynovitis. Repeat synovectomy was suggested; however, additional treatment was held by the family due to the patient's cognitive decline.

The aim of this report is to describe an atypical presentation of MAC-induced tenosynovitis. Patients diagnosed with a MAC infection should be treated promptly and informed of the possibility of recurrence. The goal of this report is to encourage practitioners to keep MAC infection on their list of differentials when evaluating abnormal wrist swelling.