Granulomatous synovitis: the role of atypical mycobacteria

Clinical data on 25 patients with granulomatous synovitis and bursitis observed from 1970 through 1977 are reviewed. The lesions occurred about the extremities, the wrists and hands being involved most often. With three exceptions, the patients had no significant underlying disease. The lesions were chronic and often followed minor trauma. Many patients had had prior surgery, steriod injections, or both. At the time of surgery for the synovitis, the gross appearance proved to be relatively characteristic, and microscopic examination revealed granulomatous inflammation. Mycobacteria were found in 20 patients. In 15 of these cases, mycobacteria were isolated in cultures; in an additional five cases, acid-fast bacilli were seen in the excised tissue but cultures were negative. The species isolated were Mycobacterium tuberculosis (four cases), Mycobacterium kansaii (six), Mycobacterium marinum (one), Mycobacterium gordonae (one), Mycobacterium avium-intracellulare (two), and Mycobacterium chelonei (one). The clinical results after therapy that combined surgery and antimicrobial agents were generally favorable. It is stressed that surgical specimens should be sent for appropriate cultures as well as for histologic study.