Mazis George A, Sakellariou Vasileios I, Kontos Fanourios, Zerva Loukia, Spyridonos Sarantis G
Department of Orthopedics, University of Utah, Salt Lake City, Utah, USA.
Orthopedics. 2011 May 18;34(5):400. doi: 10.3928/01477447-20110317-23.
This article presents a case of a painless fluctuant mass on the volar aspect of the wrist and forearm of an immunocompetent 45-year-old man with no history of significant underlying disease. This mass proved to be a chronic tenosynovitis associated with Mycobacterium kansasii infection. The patient, who had a history of multiple minor cuts and abrasions plus exposure to an aquatic environment, had a wide resection of the lesion and elective tenosynovectomy. Operative findings revealed a marked tenosynovitis of flexor tendons. Several rice bodies lesions were also observed along the course of the involved flexor tendons.Biopsy showed a granulomatous inflammatory reaction. Specimens of affected tissue were sent to a laboratory for solid (at 30°C and at 37°C) and liquid (at 37°C) mycobacterial culture. The initial Ziehl-Neelsen stain for acid-fast bacilli was positive. After 8 days of incubation, acid-fast bacilli were recovered. In accordance with the diagnosis of M kansasii tenosynovitis and the results of antibiotic susceptibility testing, triple therapy with rifampicin, isoniazid and clarithromycin was initiated. After 3 months of therapy, the patient experienced improvement in the swelling and is due to receive 12 months of antibiotic therapy. Despite awareness of atypical mycobacterial infections, diagnosis is frequently delayed, leading to increased morbidity. Patients with exposure to these atypical pathogens require a broadened differential to include appropriate testing and culture of specimens to obtain an accurate diagnosis.
本文介绍了一例病例，患者为一名45岁免疫功能正常的男性，无重大基础疾病史，其手腕掌侧和前臂出现无痛性波动性肿块。该肿块被证实为与堪萨斯分枝杆菌感染相关的慢性腱鞘炎。该患者有多次轻微割伤和擦伤史，且接触过水生环境，对病变进行了广泛切除及选择性腱鞘切除术。手术发现屈肌腱有明显的腱鞘炎。在受累屈肌腱走行过程中还观察到多个米粒体病变。活检显示为肉芽肿性炎症反应。将受影响组织的标本送去进行固体（30°C和37°C）和液体（37°C）分枝杆菌培养。最初的抗酸杆菌萋-尼染色呈阳性。培养8天后，分离出抗酸杆菌。根据堪萨斯分枝杆菌腱鞘炎的诊断及抗生素药敏试验结果，开始使用利福平、异烟肼和克拉霉素进行三联治疗。治疗3个月后，患者肿胀情况有所改善，预计将接受12个月的抗生素治疗。尽管人们已认识到非典型分枝杆菌感染，但诊断往往会延迟，导致发病率增加。接触这些非典型病原体的患者需要扩大鉴别诊断范围，包括对标本进行适当检测和培养以获得准确诊断。
