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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Treatment for flexor tendon tenosynovitis with rare non-tuberculous Mycobacteriosis (M. haemophilum): A case report

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  • presenting/speaker Kosuke Saito - The Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
  • Takuya Yokoi - The Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
  • Takuya Uemura - The Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
  • Mitsuhiro Okada - The Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
  • Ema Onode - The Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
  • Hiroaki Nakamura - The Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-423

doi: 10.3205/19ifssh0158, urn:nbn:de:0183-19ifssh01589

Published: February 6, 2020

© 2020 Saito et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Background: We need to keep non-tuberculous mycobacteria for recurrent flexor tendon tenosynovitis with poor inflammatory findings in mind. Mycobacterium haemophilum (M. haemophilum) belongs to the group of non-tuberculous mycobacteria and is rarely reported as a cause of upper extremity and hand infections. Now we report surgical treatment for flexor tendon tenosynovitis due to M. haemophilum.

Case: A 73-year-old female patient was admitted with chronic flexor tendon synovitis of the left middle finger. She had a history of living renal transplantation and oral administration of immunosuppressant. Three debridements were carried out and wound swabs were taken. In the initial surgery of middle finger, acid-fast bacteria was found. As the swelling gradually appeared on the left thumb, second synovectomy for thumb were carryed out and histologically a granulomatous infection with Langerhans cells was revealed. Mycobacterium haemophilum was identified by genetic examination. Medication was started with clarithromycin,rifampicin,moxifloxacin and rifabutin. Six months after second operation, synovitis of middle finger recurred. Third synovectomy was performed, and M. haemophilium was detected again.

Discussion: M. haemophilum infection is very rare. Althogh there are few reports of pulmonary lesions and skin lesions in immunocompromised patients, M haemophilum is rarely reported as a cause of flexor tendon tenosynovitis. It is difficult to identify this bacteria by conventional method and standard therapeutic regimen is unknown. The multiple drug combination of acid-fast bacteria is used and the administration period tends to be long term.

Conclusion: We experienced recurrent cases of M. haemophilum of the flexor tendon. It is necessary to keep this bacteria in mind for recurrent flexor tendon tenosynovitis of immunocompromised patient.