J Wrist Surg 2021; 10(03): 241-244
DOI: 10.1055/s-0040-1715803
Case Report

Mycobacterium Immunogenum Flexor Tenosynovitis: A Case Report

Jomar N. A. Aryee
1   Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
,
Sheriff D. Akinleye
2   Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
,
Aaron M. Freilich
2   Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
,
D. Nicole Deal
2   Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
› Author Affiliations
Funding None.

Abstract

Background Nontuberculous mycobacterial (NTM) flexor tenosynovitis represents a rare but potentially devastating manifestation of upper extremity infection. We present a novel case of NTM flexor tenosynovitis in which Mycobacter iumimmunogenum was found to be the causative agent.

Case Description The patient presented with pain and insidiously progressive swelling and required multiple operative interventions and a complex antimicrobial regimen based on susceptibility profiles. Specifically, our patient was managed with three debridements and empiric antimicrobial agents based on inherent macrolide sensitivity, with later conversion to a complex antimicrobial regimen tailored to sensitivity.

Literature Review The diagnosis and management of NTM tenosynovitis arechallenging because of low suspicion, nonspecific presentation, and cumbersome laboratory identification techniques. M. immunogenum was only characterized in the past two decades, and, to our knowledge, this is the first reported case of the pathogen causing a musculoskeletal infection.

Clinical Relevance We present this case primarily because of the novelty of the organism and to demonstrate the recalcitrant nature of the infection. Due to the extensive resistant patterns of M. immunogenum, management requires complex antimicrobial preparations and almost certainly needs multispecialty collaboration between orthopaedic surgery and infectious diseases.

Note

The case described was managed at the University of Virginia.




Publication History

Received: 04 May 2020

Accepted: 06 July 2020

Article published online:
31 August 2020

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