MYCOBACTERIUM KANASIIFLEXOR TENOSYNOVITIS OF THE FINGER

Abstract

We report an extreme case of Mycobacterium kanasii flexor tenosynovitis with flexor tendon rupture in a healthy 65-year-old left-hand dominant Caucasian housewife. This case highlights the diagnostic conundrum of atypical mycobacteria infections due to their insidious presentation, the need for a high index of suspicion to prevent worsening or delaying the diagnosis from inappropriate steroid use and that these infections can occur in otherwise healthy individuals.

Chronic Tenosynovitis of the Upper Extremities Caused by Mycobacterium kansasii: A Clinical Case and Systematic Review of Literature

“…10,16,19,20 Tendon rupture was found in three (13%) patients as a complication of the disease. 1,18,19 All the diagnoses were confirmed with a microbiological culture of the tissue. Regarding treatment, seven (30.4%) patients underwent previous surgeries before definitive diagnosis to try to relieve the symptoms.…”

“…1,[9][10][11][12][13][14][15] The median of the time period between the first appearing of symptoms and the definitive diagnosis was 7 months (interquartile range: 9, range: 2-48). The most frequent symptoms were local swelling (65.2%), 1,6,8,[10][11][12][13][14][16][17][18][19] pain (56.5%), 1,6,7,9,10,12,15,[18][19][20] mass effect (26%), 5,9,12,13,15 and stiffness (13%). 7,9 Twelve (52.2%) patients received an initial immunosuppressive therapy.…”

“…7,9 Twelve (52.2%) patients received an initial immunosuppressive therapy. 131,[6][7][8]13,[18][19][20] Two (8.7%) of these patients received this treatment due to similar presentation to their previous RA disease 1,13 and one (4.3%) due to previous episodes of joints pain. 19 Other immunosuppressive medical conditions included polymyositis, 9 diabetes mellitus, 10,12 scleroderma, 11 kidney transplantation, 1,15 and rheumatic polymyalgia.…”

“…Resistance to isoniazid was found in two patients, 10,19 two patients stopped treatment due to adverse effects to ethambutol, 14,16 one to rifampin, 6 and one to clarithromycin. 14 Definitive treatment such as tenosynovectomy, surgical debridement, synovial biopsy, and antibiotic therapy alone were performed in ten (43.5%), 7,8,10,13,[15][16][17]19,20 nine (39.1%), 1,6,9,12,18 two (8.7%), 19 and two (12.5%) 11,14 cases, respectively. The rate of recurrence of symptoms in patients with tenosynovectomy was 50% whereas in patients who underwent surgical debridement was 22%.…”

“…This finding suggests the insidious presentation of the disease and the delayed diagnosis probably caused by the nonspecific symptoms such as swelling, pain, mass effect, and stiffness 1,5,7,9,13,[18][19][20]22 that can be confused to be an expression of other conditions such as carpal tunnel syndrome, 10,16,19,20 previous history of joints pain, 19 or RA. 1,13 First immunosuppressive therapy was given in almost half of the patients probably because of attribution of symptoms to tenosynovitis caused by a history of RA or joints pain 1,13,19 or mechanical causes, [6][7][8]18,20 or as a therapy for a previous immunologic condition. 9,11,14,15 This therapy could worsen the infection and could have been predisposed to tendon rupture in three cases.…”