Granulomatous Tenosynovitis of the Volar Wrist from Mycobacterium Avium Complex - A Case Report.

Eric Taris, Christopher Guerra, Parth A Goenka, Jeffrey A Marchessault
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Abstract

Introduction: Mycobacterium avium complex (MAC) musculoskeletal (MSK) involvement is a rare clinical presentation of the upper extremity. When MSK involvement does occur, hand and wrist involvement are the most often reported due to the rich synovial fluid environment in these regions. This report describes an unusual case of tenosynovitis of the hand, in which a patient presented with a prolonged course of wrist pain due to MAC.

Case report: An 87-year-old Caucasian, right-handed female presented with a 2-year history of right wrist pain and swelling. There had been no previous trauma or immunocompromised state. The patient was hospitalized for severe pneumonia 2 years ago, with wrist pain developing in the months after discharge. The treatment course included radical synovectomy and subsequent triple antibiotic therapy upon confirmation of MAC rice bodies. Due to advanced age and worsening dementia, the patient did not follow-up until 2 years post-operatively. Upon return at 2 years postoperatively, the patient had concerns of recurrent tenosynovitis. Treatment was declined by the family at this time and the patient did not return again until 5 years postoperatively with continued worsening tenosynovitis. Repeat synovectomy was suggested; however, additional treatment was held by the family due to the patient's cognitive decline.

Conclusion: The aim of this report is to describe an atypical presentation of MAC-induced tenosynovitis. Patients diagnosed with a MAC infection should be treated promptly and informed of the possibility of recurrence. The goal of this report is to encourage practitioners to keep MAC infection on their list of differentials when evaluating abnormal wrist swelling.

禽分枝杆菌复合菌引起掌侧腕关节肉芽肿性腱鞘炎1例。
鸟分枝杆菌复合体(MAC)累及肌肉骨骼(MSK)是上肢罕见的临床表现。当MSK受累时,由于这些区域丰富的滑液环境,手和手腕受累是最常报道的。本报告报告了一例罕见的手部腱鞘炎病例,患者表现为由于mac引起的长时间手腕疼痛。病例报告:一位87岁的白人右撇子女性,有2年的右手腕疼痛和肿胀史。既往无外伤或免疫功能低下。患者2年前因严重肺炎住院,出院后数月出现手腕疼痛。治疗过程包括根治性滑膜切除术和确认MAC稻体后的三联抗生素治疗。由于高龄和痴呆加重,患者直到术后2年才随访。术后2年返回时,患者担心复发性腱鞘炎。此时患者的家人拒绝了治疗,患者直到术后5年才再次复发,腱鞘炎持续恶化。建议重复滑膜切除术;然而,由于患者的认知能力下降,家属坚持进行额外的治疗。结论:本报告的目的是描述mac诱导的腱鞘炎的非典型表现。确诊为MAC感染的患者应及时治疗,并告知复发的可能性。本报告的目的是鼓励从业人员在评估异常手腕肿胀时将MAC感染列入其鉴别清单。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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