DOI: http://dx.doi.org/10.18203/2349-2902.isj20214385

Chronic osteomyelitis of the hand by Mycobacterium kansasii in an immunocompromised patient

Jorge Adrián Garza Cerna, Raúl Omar Martínez Zarazúa, Everardo Valdes Flores, M. Mauricio Manuel Perez García, Gabriel Angel Mecott Rivera

Abstract


Atypical mycobacteria are pathogens that uncommonly infect the hand. These organisms are capable of causing extensive bone damage in the hand. Mycobacterium kansasii is a slow growing non-tuberculous Mycobacterium. It is the second most common non-tuberculous Mycobacterium that mainly affects the hand and joints. Immunosuppressed patients are more likely to develop infection. Because extrapulmonary involvement of M. kansasii is rare, skin and soft tissue infections are infrequent; osteomyelitis is even rarer. Immunosuppressed patients are more likely to develop infection. A history of trauma is frequent. There is a delay in diagnosis antibiotics have been given with no response. Imaging studies are recommended in the diagnostic approach, with magnetic resonance imaging being the best option to show bone and soft tissue involvement. Infected tissue culture has greater sensitivity for diagnosis. Treatment for musculoskeletal involvement consists of multiple susceptibility-based antibiotics and antiretroviral therapy in HIV coinfection, combined with surgical management with incision and drainage.


Keywords


Hand osteomyelitis, Non-tuberculous Mycobacterium, Immunocompromised

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References


Minkin BI, Mills CL, Bullock DW, Burke FD. Mycobacterium kansasii osteomyelitis of the scaphoid. J Hand Surg. 1987;12(6):1092-4.

Wada A, Nomuram S, Ihara F. Mycobacterium kansasii flexor tenosynovitis presenting as carpal tunnel syndrome. J Hand Surg. 2000;25(3):308-10.

Bhatt K, Banavathi K. Mycobacterium kansasii osteomyelitis - a masquerading disease. JMM Case Rep. 2018;5(1):e005114.

Bollam R, Phan T. Mycobacterium marinum infection of the hand presenting as a nodular skin lesion. J Clin Tuberc Other Mycobact Dis. 2020;20:100166.

Huayllani MT, Sisti A, Boczar D, Restrepo DJ, Parker AS, Sarabia-Estrada R, Rinker BD, Forte AJ. Chronic Tenosynovitis of the Upper Extremities Caused by Mycobacterium kansasii: A Clinical Case and Systematic Review of Literature. Indian J Plast Surg. 2020;53(1):25-35.

Smith MB, Molina CP, Schnadig VJ, Boyars MC, Aronson JF. Pathologic Features of Mycobacterium kansasii Infection in Patients with acquired Immunodeficiency Syndrome. Arch Pathol Lab Med. 2003;127(5):554-60.

Menashe L, Kerr LD, Hermann G. Mycobacterium kansasii causing chronic monoarticular synovitis in a patient with HIV/AIDS. J Radiol Case Rep. 2015;9(9):26-35.

Napaumpaiporn C, Katchamart W. Clinical manifestations and outcomes of musculoskeletal non-tuberculous mycobacterial infections. Rheumatol Int. 2019;39(10):1783-7.

Formanoy E, Lam HY, Arends JE, Tenosynovitis of the right hand, Netherlands. J Med. 2013;7(1):10.

Balagué N, Uçkay I, Vostrel P, Hinrikson H, Van Aaken I, Beaulieu JY. Non-tuberculous mycobacterial infections of the hand. Chir Main. 2015;34(1):18-23.

Wang MS, Berry M, Lehto-Hoffman A, Vi L, Ramessar N. Chronic Tenosynovitis due to Mycobacteria kansasii in an Immunocompetent Host. Case Rep Infect Dis. 2018;2018:3297531.

Pastorino A, Tavarez MM. Incision and Drainage. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. Available at: https://www.ncbi.nlm.nih.gov/books/NBK556072/. Accessed on 2021 July 31.

Johnston JC, Chiang L, Elwood K. Mycobacterium kansasii. Microbiol Spectr. 2017;5(1).

Mazis GA, Sakellariou VI, Kontos F, Zerva L, Spyridonos SG. Recurrent fluctuant mass of the wrist and forearm associated with chronic tenosynovitis by Mycobacterium kansasii. Orthopedics. 2011;18;34(5):400.