Radical Surgical Debridement Alone for Treatment of Carpal Tunnel Syndrome Caused by Mycobacterium Avium Complex Flexor Tenosynovitis: Case Report

doi:10.1016/j.jhsa.2011.03.008

The Journal of Hand Surgery

Volume 36, Issue 6, June 2011, Pages 1047-1051

https://doi.org/10.1016/j.jhsa.2011.03.008 Get rights and content

We present a case of proliferative flexor tenosynovitis caused by Mycobacterium avium complex resulting in recurrent symptoms of median nerve compression. The patient was treated with radical tenosynovectomy and release of the carpal tunnel without antimicrobial therapy. She remains symptom-free and is apparently disease-free more than 2 years after surgery.

Section snippets

Case Report

A previously healthy, 77-year-old woman presented to our unit with a 5-year history of persistent swelling about the volar aspect of the right wrist and recurrent symptoms consistent with carpal tunnel syndrome. Her past medical history was noteworthy only for hypertension and osteoarthritis. Five years previously, at another institution, she had had right carpal tunnel release. Two years later, she presented to the same institution with right wrist swelling and recurrent median nerve symptoms.

Discussion

Atypical mycobacteria are opportunistic organisms that can be found throughout the environment.¹¹ Although perhaps best described as causing lung disease, atypical mycobacteria also cause skin infections, cervical lymphadenitis, bone and joint infections, and disseminated disease.2, 11 Various authors have described the role of these organisms, including MAC, as a rare cause of upper extremity tenosynovitis and carpal tunnel syndrome.1, 3, 8, 12, 13, 14, 15, 16 The increasing importance of

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Cited by (11)

Nonmarinum, Nontuberculous Mycobacterial Infections of the Upper Extremity: A Multi-Institutional Descriptive Report
2023, Journal of Hand Surgery
Citation Excerpt :
In our study, 62 patients (81%) had inappropriate treatment prior to presentation at our institution, including localized corticosteroid injections and antimicrobial therapy directed toward routine bacterial infections. Current recommendations for treatment of invasive NTMIs include a combination of debridement and antibiotics.37–40 In our cohort, all patients underwent surgical debridement; of those, 4 ultimately underwent amputation for disease eradication.
We analyzed patient demographic factors involved in the development of nonmarinum, nontuberculous mycobacterial infections (NTMI) involving the upper extremity, and assessed diagnostic and prognostic values of commonly used preoperative laboratory and imaging studies, as well as factors related to recurrence of disease and patient outcomes.
Patients from 2 academic, tertiary facilities with culture-proven, nonmarinum NTMI involving the upper extremity were reviewed. Patient-related factors and clinical outcomes were extracted. The analysis was based on pathogen identification (rapid- vs slow-growing subspecies) and immune status.
Our 76 patients had a mean age of 59 years, and 65% were male. Forty-eight percent reported an injury, and hands were frequently involved (58%). Forty-one percent were immunosuppressed (19% organ transplant recipients). The mean symptom duration prior to presentation was 203 days. The culture identification took a mean of 33 days, with 25 different species identified (subcategorized as rapid or slow growers). Seventy-seven percent had solitary lesions, with a cutaneous or subcutaneous location most common. Immunosuppressed patients were treated longer with antibiotics (243 vs 155 days in immunocompetent patients) and experienced higher rates of side effects, complications, and recurrence. All patients underwent debridement to control infection, including 4 individuals who required amputations. One-third experienced complications and/or recurrence, regardless of the organism type.
Upper-extremity nonmarinum NTMI is often misdiagnosed, causing management delays. Early consideration in differential diagnoses of chronic, painful swelling, nodular or inflammatory lesions, or septic arthritis is crucial. Tissue biopsy with specimens for histopathology and microbiological analysis (mycobacterial smear, cultures, and broad range polymerase chain reaction) and early involvement with an infectious disease specialist are recommended. Empiric antibiotic therapy is not standard. Debridement and prolonged, directed combination antimicrobial therapy is required; however, adverse reactions are commonly encountered.
Prognostic IV.
Infectious Tenosynovitis of the Tibialis Anterior Due to Mycobacterium chelonae After Intravenous Heroin Injection
2020, Journal of Foot and Ankle Surgery
Mycobacterium chelonae is a ubiquitous Gram-positive, acid-fast, non–spore-forming bacterium commonly encountered in nature associated with aquatic animals, soil, and water, including tap water. Nontuberculous mycobacterial tenosynovitis infections caused by M. chelonae in the lower extremity are uncommon, leading to a paucity of literature documenting the diagnosis and treatment of such cases. This report is of a 65-year-old male patient who was found to have an M. chelonae infection along the tibialis anterior tendon after injecting himself with heroin into the dorsal foot veins. This review covers the diagnosis and treatment as well as a case report on the outcome of infectious tenosynovitis of the tibialis anterior associated with M. chelonae. To date, this is the only reported case of tibialis anterior infectious tenosynovitis caused by M. chelonae after intravenous heroin injection.
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Septic Mycobacterium Avium Intracellulare Extensor Tenosynovitis of the Wrist
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Combined administration of rifampicin, ethambutol, and clarithromycin for the treatment of tenosynovitis of the hand caused by Mycobacterium avium complex: Case series and literature review
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Reconstruction with a free temporoparietal fascia flap for intractable flexor tenosynovitis of the wrist accompanied by a soft tissue defect: a case report
2021, Case Reports in Plastic Surgery and Hand Surgery

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Scientific articleRadical Surgical Debridement Alone for Treatment of Carpal Tunnel Syndrome Caused by Mycobacterium Avium Complex Flexor Tenosynovitis: Case Report

Section snippets

Case Report

Discussion

J Hand Surg

J Hand Surg

J Hand Surg

Clin Chest Med

Diagn Microbiol Infect Dis

Diagn Microbiol Infect Dis

Non-tuberculous mycobacterial tenosynovitis: a review

Scand J Infect Dis

Nontuberculous mycobacterial infections: a clinical review

Infection

Tenosynovitis and carpal tunnel syndrome from mycobacterium tuberculosis—a rare manifestation of extrapulmonary tuberculosis

Acta Reumatol Port

An uncommon cause for a common complaint

Hand Surg

Localized soft-tissue infections with Mycobacterium avium/Mycobacterium intracellulare complex in immunocompetent patients: granulomatous tenosynovitis of the hand or wrist

Clin Infect Dis

Scientific article
Radical Surgical Debridement Alone for Treatment of Carpal Tunnel Syndrome Caused by Mycobacterium Avium Complex Flexor Tenosynovitis: Case Report