Atraumatic Pyogenic Extensor Tenosynovitis of the Extensor Digitorum Longus

Abstract

Pyogenic tenosynovitis occurs almost exclusively in the flexor tendons of distal extremities, more commonly in the hand/wrist than the ankle/foot. Most commonly documented in the literature of the rarer extensor pyogenic tenosynovitis are case reports in the upper extremities caused by atypical bacteria or fungi, with only two cases caused by Staphylococcus aureus. It is rare for isolated tenosynovitis to occur in the extensor tendons of the lower extremity in a patient with no known trauma, IV drug use, or significant comorbidities. We report a case of a 22-year-old male who presented with a two-day history of progressive dorsolateral foot erythema, swelling, and pain. He denied any history of trauma or evidence of foot wounds, abrasions, or punctures. His examination and ultrasound were consistent with extensor tenosynovitis of the extensor digitorum longus. He was treated with intravenous antibiotics and surgical irrigation and debridement. Intraoperatively, a large phlegmon was identified in the tenosynovium. His symptoms resolved postoperatively, and he made a full recovery with no deficits. Pyogenic extensor tenosynovitis warrants consideration in the differential diagnosis of patients presenting with isolated dorsolateral foot erythema, swelling, and pain, despite no history of trauma or intravenous drug use.

Infectious Extensor Tenosynovitis of the Hallucis Longus Tendon: A Case Report

“…Septic tenosynovitis is an infection that involves the tendon and its synovial sheath, which provides an ideal environment for pathogens to grow in isolation [ 9 ]. Typically, these infections involve the flexor tendons of the hand as opposed to the lower extremities [ 1 ]. Foreign bodies secondary to trauma are the most common cause of tenosynovitis in the foot [ 10 ].…”

“…Tenosynovitis, an inflammatory condition affecting a tendon and its sheath, can be caused by trauma, overuse, autoimmune inflammatory processes, foreign bodies, or infection [ 1 ]. Treatment options for infectious tenosynovitis include antibiotics and surgical debridement [ 2 ].…”

Bilateral Infectious Extensor Tenosynovitis: A Case Report

“…[3][4][5] The extensor tendons are less isolated than flexor tendons; so infection is less likely to be localized exclusively to the extensor tendons. 2 Findings of extensor tenosynovitis can be nonspecific but include pain, edema, and erythema on the dorsum of the extremity. 2,5 Clinical Practice and Cases in Emergency Medicine…”

“…2 Findings of extensor tenosynovitis can be nonspecific but include pain, edema, and erythema on the dorsum of the extremity. 2,5 Clinical Practice and Cases in Emergency Medicine…”

“…As with most hand infections, patients usually report trauma or preceding intravenous (IV) drug use, and the classic dogma is that infections occur unilaterally. 2,3 Here we report a case of bilateral extensor tenosynovitis in a patient denying direct trauma or IV drug use.…”