The Histopathology of Mycobacterium marinum Synovitis

Abstract

Eight patients with culture-proven Mycobacterium marinum synovitis had synovial specimens with a remarkably similar histologic appearance. There was considerable synovial hyperplasia, and the synovium was thickened by a moderately intense lymphohistiocytic infiltrate, notably devoid of plasma cells. Fibrin covered some synovial surfaces. Giant cells were both of the Langerhans' and foreign body types. Granulomas were noncaseating but varied in frequency and degree of definition. Knowledge of this morphologic picture has proved to be useful in patient care.

Synovial biopsy

“…Nevertheless, all mycobacterium infections are not of tuberculous origin, and a notable exception is synovitis produced by M. marinum, which involves the tendon sheaths, bones and joints [2,6,13]. In this infection the changes vary from the common nonspecific inflammation to the granulomatous response, with or without caseation.…”

Agents of newly recognized or infrequently encountered mycobacterial diseases

“…5,1992 3 line reference (234) and have been described more extensively in subsequent reviews devoted to this condition (32,91). Recent literature has emphasized the deeper infections, usually of the hand and including tenosynovitis, arthritis, bursitis, and osteomyelitis (12,30,84). Almost all cases are associated with some aquatic activity, usually involving fish.…”

“…The increase in proportion of published reports dealing with these deep infections probably reflects an increased awareness of these conditions, resulting in more frequent diagnosis, as well as the recognition of the serious consequences of inadequately treated deep infections (17). These lesions are usually characterized by noncaseating granulomas and an absence of plasma cells (12,84). Chemotherapy with some combination of drugs such as rifampin and ethambutol is usually effective, but surgery may be required (30,84).…”

“…In both patients, the pulmonary lesions resolved rapidly under regimens that included rifampin, ethambutol, and streptomycin (229 The frequency with which the fastidious mycobacterial species are encountered may be too low to justify commercial production of the specially enriched media needed for each. Moulsdale and colleagues (132) 12 weeks before being discarded as negative. Skin specimens may also be cultured for M. malmoense by using the media described below.…”

Agents of newly recognized or infrequently encountered mycobacterial diseases.

“…Cutaneous manifestations of M. marinum infections were discussed in the base-line reference (234) and have been described more extensively in subsequent reviews devoted to this condition (32,91). Recent literature has emphasized the deeper infections, usually of the hand and including tenosynovitis, arthritis, bursitis, and osteomyelitis (12,30,84). Almost all cases are associated with some aquatic activity, usually involving fish.…”