Experience with atypical mycobacterial infection in the deep structures of the hand.

Two new cases of atypical mycobacterium infections of the deep structures are reported. With two reported previously by the authors and a review of 24 others recorded by others, the symptoms and signs are reviewed. Typically it occurs in the middle-aged person, some of whom give a history of a puncture wound within 6 weeks of onset of symptoms. Synovium in the finger is involved commonly and a carpal tunnel syndrome may be the result of involvement of the bursae. Fever does not occur and no systemic signs are present. Biopsy and cultures are essential for diagnosis, but a presumptive diagnosis indicates that, after synovectomy, treatment should be started with antituberculous drugs, isoniazid with ethambutol, Rifampin, or both and continued for 18 to 24 months, unless in vitro sensitivity tests indicate a change of medication. The usual organisms are M. kansasii, M. marinum, M. intracellulare, and M. avium.