The carpal tunnel syndrome caused by Arthrinium phaeospermum infection: first case report and literature review

Abstract

Background: The carpal tunnel syndrome(CTS) caused by atypical infectious is a therapeutic and diagnostic challenge. Because non-specific clinical presentation often result in misdiagnosis and incorrect therapy, failing to elicit an accurate exposure. Case presentation: This article reports a case of deep infection leading to CTS manifestations. A male patient was admitted for numbness and pain of the left hand. Left carpal tunnel release, median nerve decompression, synovectomy of the carpal tunnel were performed. Inflamed synovium and effusion were submitted for bacterial culture and metagenomic next-generation sequencing(mNGS). The causing pathogen was identified as Arthrinium phaeospermum and the patient recovered after surgical debridement and 10 months of antimicrobial therapy. Conclusions: Diagnosis of fungi infection of the hand is challenging as the presentation mimics other conditions without much histological findings. NGS is proposed of great importance adjunctive diagnostic approach for identifying atypical infectious quickly.