Speaker Credentials
MS-II
College
College of Allopathic Medicine
Medical Specialty
Orthopedic Surgery
Format
Poster
Start Date
November 2024
End Date
November 2024
Track
4
Abstract
Title: Flexor Tenosynovitis of the Wrist and Hand Due to Non-tuberculous Mycobacteria Authors: Mariafe Reyes1,Tatevik Malisetyan1, Skylar Harmon1, Mohammadali M. Shoja, MD1 Gary B. Schwartz, MD1 1Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA INTRODUCTION: Non-tuberculous mycobacteria (NTM) are a group of bacteria, including Mycobacterium marinum, Mycobacterium kansasii, and Mycobacterium avium intracellulare (MAI), that usually exist in the soil and water sources. The most common site of infection is the lungs, but extra-pulmonary involvement of the skin and rarely the musculoskeletal (MSK) system does occur, especially the hands and wrists. CASE PRESENTATION: A 45-year-old, immunocompromised, right-handed patient presented with persistent swelling in the left hand, wrist, and distal forearm. A comprehensive physical examination, imaging, and subsequent flexor tenosynovectomy with histopathological examination was completed. The patient underwent long term antibiotic therapy, occupational hand therapy, and post-operative follow-up. Within four months postoperatively the patient experienced considerable improvement in symptomatology and hand functionality, without evidence of disease progression. DEVIATION FROM EXPECTED: This case emphasizes the importance of maintaining heightened suspicion for NTM infection during the evaluation of chronic hand swelling with increased emphasis in immunocompromised patients. CONCLUSION: Timely diagnosis through the correlation of clinical and diagnostic findings can prevent delays leading to detrimental consequences. A comprehensive approach using acid-fast stain, cultures, histological examination, and imaging is recommended due to the challenging nature of diagnosing NTM tenosynovitis. The utilization of MRI is essential for determining the extent of infection and involvement of adjacent structures. The presence of rice bodies, although not pathognomonic, can suggest NTM infection and serve as an additional contributing factor when other etiologies of chronic hand swelling are ruled out. Effective management involves prompt surgical intervention and referral to an infectious disease (ID) specialist for appropriate selection of antibacterial therapy.
Flexor Tenosynovitis of the Wrist and Hand Due to Non-tuberculous Mycobacteria
Title: Flexor Tenosynovitis of the Wrist and Hand Due to Non-tuberculous Mycobacteria Authors: Mariafe Reyes1,Tatevik Malisetyan1, Skylar Harmon1, Mohammadali M. Shoja, MD1 Gary B. Schwartz, MD1 1Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA INTRODUCTION: Non-tuberculous mycobacteria (NTM) are a group of bacteria, including Mycobacterium marinum, Mycobacterium kansasii, and Mycobacterium avium intracellulare (MAI), that usually exist in the soil and water sources. The most common site of infection is the lungs, but extra-pulmonary involvement of the skin and rarely the musculoskeletal (MSK) system does occur, especially the hands and wrists. CASE PRESENTATION: A 45-year-old, immunocompromised, right-handed patient presented with persistent swelling in the left hand, wrist, and distal forearm. A comprehensive physical examination, imaging, and subsequent flexor tenosynovectomy with histopathological examination was completed. The patient underwent long term antibiotic therapy, occupational hand therapy, and post-operative follow-up. Within four months postoperatively the patient experienced considerable improvement in symptomatology and hand functionality, without evidence of disease progression. DEVIATION FROM EXPECTED: This case emphasizes the importance of maintaining heightened suspicion for NTM infection during the evaluation of chronic hand swelling with increased emphasis in immunocompromised patients. CONCLUSION: Timely diagnosis through the correlation of clinical and diagnostic findings can prevent delays leading to detrimental consequences. A comprehensive approach using acid-fast stain, cultures, histological examination, and imaging is recommended due to the challenging nature of diagnosing NTM tenosynovitis. The utilization of MRI is essential for determining the extent of infection and involvement of adjacent structures. The presence of rice bodies, although not pathognomonic, can suggest NTM infection and serve as an additional contributing factor when other etiologies of chronic hand swelling are ruled out. Effective management involves prompt surgical intervention and referral to an infectious disease (ID) specialist for appropriate selection of antibacterial therapy.