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Orthopaedics
Management of atypical Mycobacterium szulgai digital flexor tenosynovitis
  1. Sebastian D Arango1,
  2. Jacob Zeitlin1,2,
  3. Fotios Kantas1 and
  4. Andrew J Miller1
  1. 1 Philadelphia Hand to Shoulder Center, Philadelphia, Pennsylvania, USA
  2. 2 Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Jacob Zeitlin; jhz4001{at}med.cornell.edu

Abstract

Mycobacterium szulgai is a rare, atypical pathogen predominantly associated with pulmonary infections but capable of causing suppurative tenosynovitis—a potentially devastating infection of the tendon sheath. This case involves a patient presenting with insidious pain and swelling of the right index finger. After multiple consultations, the patient was indicated for surgical exploration which revealed significant flexor tendon sheath tenosynovitis and inflammation with subsequent cultures growing M. szulgai. The patient was treated with a broad-spectrum antibiotic regimen, adjusted postoperatively based on culture results. Significant improvements in finger mobility and swelling reduction were observed by the 6-week follow-up. This case emphasises the necessity of comprehensive diagnostic evaluation and precise antimicrobial therapy in managing rare mycobacterial infections, contributing valuable insights to the limited literature on non-tuberculous mycobacterial tenosynovitis.

  • Orthopaedics
  • Bone and joint infections
  • Orthopaedic and trauma surgery
  • Tuberculosis
  • Blood Culture

https://doi.org/10.1136/bcr-2024-263027

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    Footnotes

    • X @jacobzeitlin

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: JZ, FK, SDA, AJM. The following authors gave final approval of the manuscript: JZ, FK, SDA, AJM.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.