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.
Keywords
Mycobacterium immunogenum
- upper extremity infection - flexor tenosynovitis - nontuberculous mycobacterium
