Mycobacterium tuberculosisInfection in the Shoulder after Reverse Total Shoulder Arthroplasty

Abstract

Cuff tear arthropathy represents a broad spectrum of pathology in which, at least to some degree, three critical features are present: rotator cuff insufficiency, degenerative changes of the glenohumeral joint, and superior migration of the humeral head. Other characteristics that may be seen are humeral head collapse, erosive changes to the superior glenoid or acromion, and subdeltoid effusion. The reverse total shoulder arthroplasty has recently received attention for the treatment of rotator cuff tear arthropathy. However, many complications of reverse total shoulder arthroplasty have also been reported, and infection is one of the major complications. CASE REPORTA 77-year-old woman visited our hospital because of heat, pain and pus discharge at the surgical site. She had underwent reverse total shoulder arthroplasty for a rotator cuff tear arthropathy two years and three months ago. And she had underwent irrigation and debridement two times due to infectious signs. But no symptoms had been improved, so she had been refered to our hospital.The medical history of the patient indicates that she was diagnosed with diabetes mellitus three years ago, and she was on medication for angina pectoris. There was no past history of immunocompromising disease. Her chief complaint was pus discharge, pain and swelling at the surgical site, 8 months after a reverse total shoulder arthroplasty. Physical examination revealed a drainage opening at the front of the right shoulder, which was in the middle area of the previous skin incision site and measured about 1 cm in diameter.The drained fluid was a dark yellowish color with relatively light viscosity. At that time we performed a Gram stain and culture, and Reverse total shoulder arthroplasty has recently received attention for treatment of rotator cuff tear arthropathy. However, many complications of reverse total shoulder arthroplasty have also been reported, and infection is a major complication. We are reporting on a case of an approximately 77-year-old female patient who underwent reverse total shoulder arthroplasty with surgical site infection caused by Mycobacterium tuberculosis. The patient had undergone irrigation and debridement two times due to infectious signs at 8 months after a reverse total shoulder arthroplasty. At the last debridement operation, we performed AFB staining, culture for Mycobacterium tuberculosis and biopsy. Mycobacterium tuberculosis was cultured and we did not hesitate to administer 4 regimen therapy for tuberculosis. The outpatient follow-up result was satisfactory without recurrence. At the time of the latest follow-up, the degree of pain and function were good.

A chronic sinus tract infection developing after suture anchoring of the ankle

“…Two case reports have appeared. [17,18] Bacterial cultures were negative, but Mycobacterium was found in the wounds. This pathogen must be considered if, postoperatively, wounds present with chronically discharging sinuses, even in healthy non-immunocompromised patients.…”