Mycobacterium Chelonei Tenosynovitis of the Hand: a Case Report and Literature Review

Mycobacterium chelonei infection of the hand, a rare disease, is difficult to treat in immunocompromised patients and its diagnosis is usually delayed. We describe a middle age woman with rheumatoid arthritis who suffered from painful swelling of her wrist despite treatment with multiple local injections of steroids for months. Under impression of tubercular tenosynovitis of the wrist, we admitted her for treatment. The surgical wound got worse even after a com-bination of four anti-tuberculosis medications were administered. Subsequent impression of mixed infection (with mycobacteria and other bacteria) resulted in treatment with stronger antibiotics and further surgical debridement, but the patient did not improve. Atypical mycobacteria (M. chelonei) were isolated 9 weeks after admission. The wound was treated with adequate antibiotics (ciprofloxin 400 mg q12h, amikacin 375 mg q12h and clarithromycin 500 mg q12h) and surgical debridement, and the condition of the wound improved. Clarithromycin 500 mg bid was administered for 12 months totally and no recurrence was evident during 2 years of follow-up. We review the literature on M. chelonei tenosynovitis of the hand and dis-cuss the treatment and outcome of this disease. Conclusion: Accurate diagnosis, adequate antibiotics and surgical intervention are essential for curing M. che-lonei tenosynovitis of the hand in immunocompromised patients.

並列關鍵字

Mycobacterium chelonei ； Tenosynovitis ； Hand

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