Τίτλος:
Recurrent fluctuant mass of the wrist and forearm associated with chronic tenosynovitis by Mycobacterium kansasii
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
This article presents a case of a painless fluctuant mass on the volar aspect of the wrist and forearm of an immunocompetent 45-year-old man with no history of significant underlying disease. This mass proved to be a chronic tenosynovitis associated with Mycobacterium kansasii infection. The patient, who had a history of multiple minor cuts and abrasions plus exposure to an aquatic environment, had a wide resection of the lesion and elective tenosynovectomy. Operative findings revealed a marked tenosynovitis of flexor tendons. Several rice bodies lesions were also observed along the course of the involved flexor tendons. Biopsy showed a granulomatous inflammatory reaction. Specimens of affected tissue were sent to a laboratory for solid (at 30°C and at 37°C) and liquid (at 37°C) mycobacterial culture. The initial Ziehl-Neelsen stain for acid-fast bacilli was positive. After 8 days of incubation, acid-fast bacilli were recovered. In accordance with the diagnosis of M kansasii tenosynovitis and the results of antibiotic susceptibility testing, triple therapy with rifampicin, isoniazid and clarithromycin was initiated. After 3 months of therapy, the patient experienced improvement in the swelling and is due to receive a total of 12 months of antibiotic therapy. Despite awareness of atypical mycobacterial infections, diagnosis is frequently delayed, leading to increased morbidity. Patients with exposure to these atypical pathogens require a broadened differential to include appropriate testing and culture of specimens to obtain an accurate diagnosis.
Συγγραφείς:
Mazis, G.A.
Sakellariou, V.I.
Kontos, F.
Zerva, L.
Spyridonos, S.G.
Περιοδικό:
Orthopedic Reviews
Λέξεις-κλειδιά:
amikacin; ciprofloxacin; clarithromycin; ethambutol; ethionamide; heat shock protein 65; isoniazid; linezolid; moxifloxacin; rifabutin; rifampicin; streptomycin, acid fast bacterium; adult; antibiotic resistance; antibiotic sensitivity; aquatic environment; arm disease; article; atypical mycobacteriosis; bacterium culture; bone biopsy; case report; disease association; environmental exposure; flexor tendon; forearm tumor; histopathology; human; incubation time; male; minimum inhibitory concentration; Mycobacterium kansasii; nucleotide sequence; skin abrasion; synovectomy; tenosynovectomy; tenosynovitis; treatment duration; treatment outcome; wrist disease; wrist tumor; atypical mycobacteriosis; chronic disease; forearm; microbiology; middle aged; Mycobacterium kansasii; recurrent disease; tenosynovitis; wrist, Chronic Disease; Forearm; Humans; Male; Middle Aged; Mycobacterium Infections, Atypical; Mycobacterium kansasii; Recurrence; Tenosynovitis; Treatment Outcome; Wrist
DOI:
10.3928/01477447-20110317-23
