Kim Jong Hyup, Koh In Chang, Lim Soo Yeon, Kang Seong Hee, Kim Hoon
Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Institute, Daejeon 35365, South Korea.
Division of Infectious Diseases, Department of Internal Medicine, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Institute, Daejeon 35365, South Korea.
World J Clin Cases. 2024 Dec 26;12(36):6926-6934. doi: 10.12998/wjcc.v12.i36.6926.
Musculoskeletal (NTM) infections are rare, particularly post-acupuncture therapy, and present diagnostic challenges due to their infrequency and potential severity. Prompt recognition and appropriate management are crucial for optimal outcomes. NTM-infected wounds involving the joints are difficult to treat, and only a few cases have been reported.
We present a case of a chronic intractable NTM-infected wound on the elbow joint that completely healed with conservative wound care and antibiotic treatment. An 81-year-old woman presented with a chronic, ulcerative wound on the right elbow joint where she had undergone repeated acupuncture therapy for chronic intolerable pain. Magnetic resonance imaging revealed synovial thickening, effusion, and subcutaneous cystic lesions. An orthopedic surgeon performed open synovectomy and serial debridement. However, 1 month postoperatively, the wound had not healed and became chronic. A wound culture revealed NTM (), and the patient was referred to the Department of Plastic and Reconstructive Surgery. Instead of surgical intervention, conservative wound care with intravenous antibiotics was provided, considering the wound status and the patient's poor general condition. Complete wound healing was achieved in 12 months, with no impact on the range of motion of the elbow joint.
With clinical awareness, musculoskeletal NTM infection can be treated with conservative wound care and appropriate antimicrobial agents.
肌肉骨骼非结核分枝杆菌（NTM）感染较为罕见，尤其是在针灸治疗后，由于其发病率低且潜在严重性，给诊断带来挑战。及时识别和恰当处理对于取得最佳治疗效果至关重要。累及关节的NTM感染伤口难以治疗，仅有少数病例报道。
我们报告一例肘关节慢性顽固性NTM感染伤口，通过保守伤口护理和抗生素治疗完全愈合。一名81岁女性因右肘关节慢性溃疡性伤口就诊，她曾因慢性难以忍受的疼痛接受多次针灸治疗。磁共振成像显示滑膜增厚、积液和皮下囊性病变。一名骨科医生进行了开放性滑膜切除术和系列清创术。然而，术后1个月伤口未愈合并转为慢性。伤口培养发现NTM（），患者被转诊至整形与重建外科。考虑到伤口状况和患者总体状况较差，未采取手术干预，而是采用静脉抗生素进行保守伤口护理。12个月时伤口完全愈合，且未影响肘关节活动范围。
通过临床认识，肌肉骨骼NTM感染可采用保守伤口护理和适当抗菌药物进行治疗。
