Article
Non-tuerculous mycobacterial tenosynovitis of the hand
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Authors
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Dong Hee Kim
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
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Jin Sung Park
- Gyungsand National University Hospital, Jinju, South Korea
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Sang Hyun Lee
- Pusan National University Hospital, Pusan, South Korea
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Sung Wook Yaung
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: The incidence of the hand among musculoskeletal infections caused by Non-tuberculous mycobacterium (NTM)is very rare. Especially, Only a small number of cases have been reported in NTM tenosynovitis of the hand, there has been controversy about appropriate treatment including antibiotic therapy, surgical debridement, and time of drug administration. We report outcomes from two Korean hospitals responding to chronic tenosynovitis of hand caused by NTM treated with surgical debridement and drug administration.
Methods: From January 2010 to December 2017, twenty patients who had a NTM tenosynovitis of the hand were treated at two center. There were 8 male and 12 female patients. The average age was 63.65 years. Symptom were present for 1~24 months (average 9.3 months). A history of trauma or operation was reported in 11 cases. The history of steroid injection before diagnosis was average 1.15 times. Most common species is Mycobacterium intracellulare (11 cases), second is Mycobacberium marium/ulcerance co-infection (3 cases). Mycobacterium chelonae, Mycobacterium abscessus, Mycobacterium Szulgai, Mycobacterium gordonae, Mycobacterium kansasii, Non-classified were each a case. All patients have been treated by combination therapy - extensive tenosynovectomy and antibiotics. The average period of antibiotic administration was 9.13 months and the mean times of surgical debridement were 2.75 times. Depending on the site of tendon involvement, surgery was required more frequently in cases of extensor tendon (average 3.86 times) than in cases of flexor tendon (average 2.0 times). (p=0.012)
Results and Conclusions: NTM tenosynovitis of the hand is rare and difficult to diagnosis and treatment. In this study, it was found that the species of mycobacterium were different from those of previously published papers, and this might be due to occupational and regional differences. And there is difference in the number of operations between the extensor tendon and flexor tendon. Because that most extensor tendons lack an extensive retinacular system, so well-localized infection of extensor tendons is rare.
Since diagnosis is often difficult, clinical suspicion is the most important step of treatment for NTM infection. It takes at least 3 months for response to combination treatment of NTM infection. Therefore, physician should explain to patient sufficient explanation of the progress of diseases.
