Infection of Synovial Tissues by Mycobacteria Other than Mycobacterium tuberculosis

Kelly, Patrick J.; Karlson, Alfred G.; Weed, Lyle A.; Lipscomb, Paul R.

doi:10.2106/00004623-196749080-00003

Cited by 99 publications

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“…This scarring occurs in 0.5% to 1.1% of patients and typically presents one year following surgery (12)(13)(14). Inflammatory tenosynovitis occurs in 0.1% to 0.7% of patients and is associated with various systemic inflammatory diseases, metabolic disorders or infectious etiologies (3,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Most recurrences due to tenosynovitis occur within months of the primary release (1,2).…”

mentioning

confidence: 99%

Anomalous flexor digitorum superficialis muscle transposition for vascular coverage of the median nerve in recurrent carpal tunnel syndrome

Neumeister¹

2005

J Plast Surg

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Recurrent carpal tunnel syndrome is uncommon yet troublesome. Significant adhesions and scarring around the median nerve can render it relatively ischemic. A number of vascular flaps have been described to provide vascular coverage in attempts to decrease further cicatricial adhesions and to improve local blood supply around the median nerve. A rare case of an anomalous muscle in the distal forearm used as tissue to provide good vascularized coverage of the median nerve that was severely scarred in its bed is reported. The anomalous muscle was distal to the flexor digitorum superficialis tendon and inserted in the palmar fascia on the ulnar aspect of the hand. Referring branches from the ulnar artery provided vascular supply to the anomalous muscle. The muscle on these vascular pedicles was transposed over the median nerve, providing good, stable, unscarred coverage. The patient had an excellent result with resolution of the carpal tunnel symptoms. The redundant anomalous muscle provided a unique vascularized source for coverage of the median nerve in recurrent carpal tunnel syndrome.

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confidence: 99%

Anomalous flexor digitorum superficialis muscle transposition for vascular coverage of the median nerve in recurrent carpal tunnel syndrome

Neumeister¹

2005

J Plast Surg

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“…A high index of suspicion for RGM infections is therefore extremely important. Previous reports (9,10) and ours suggest that patients with a history of localized trauma or intra-articular injection of steroids, regardless of their immunity status, are at high risk for septic arthritis due to RGM.…”

Section: Case Reportmentioning

confidence: 44%

Prosthetic Joint Infection Caused by Mycobacterium alvei in an Elderly Patient

et al. 2011

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We report the first case of prosthetic joint infection caused by Mycobacterium alvei, which was identified by PCR-restriction fragment length polymorphism and verified by analysis of nucleotide sequences of its amplified 16S ribosomal DNA. The pathogen was susceptible to linezolid, amikacin, ciprofloxacin, tigecycline, and trimethoprim-sulfamethoxazole. The clinical implications are discussed. CASE REPORTA 75-year-old woman received hemiarthroplasty and underwent bipolar endoprosthesis replacement for osteoarthritis involving her left knee. She had received numerous intra-articular injections of steroids for pain relief over her left knee before this procedure. Pain, redness, and swelling began insidiously developing over her left knee 2 months after the arthroplastic surgery. Laboratory tests disclosed an elevated erythrocyte sedimentation rate (ESR, 125 mm/h [normal is Ͻ20 mm/ h]). Her chest radiograph was normal. During left-knee arthroscopic surgery, prosthetic implant loosening with extensive periprosthetic tissue necrosis was found. Analysis of synovial fluid revealed a leukocyte count of 10,424 cells/l with 75% polymorphonuclear cells. Synovial fluid was negative for Gram staining and for aerobic and anaerobic bacterial cultures. The histopathology of the excised synovial tissue suggested acute and chronic inflammation. Resection arthroplasty was performed, and antibiotic-loaded cement beads (vancomycin, piperacillin, and amikacin in polymethylmethacrylate [PMMA]) were implanted. The patient then received intravenous teicoplanin injection for 4 weeks, followed by oral fusidic acid and rifampin for maintenance therapy, because methicillin-resistant Staphylococcus aureus was assumed to be the most likely culprit pathogen for her prosthetic joint infection (PJI).Three months later, her PJI did not improve clinically, and her ESR was 151 mm/h, suggesting an intractable infection. A computed tomography scan revealed an edematous change in the muscular structure around the left knee and a loculated abscess located medial to the tibialis posterior. A pocket with yellowish necrotic tissue-like content in the soft tissue near the synovial membrane of the left knee was found at an exploratory surgery. The histopathology of the excised synovial membrane disclosed granulomatous inflammation with the presence of multinucleated giant cells. Both acid-fast staining and Gram staining were negative. Culture of the excised synovium by spreading it on 5% sheep blood agar for 48 h of incubation turned out to be negative. Spreading of the excised synovium on egg-based Lowenstein-Jensen slants (bioMérieux, La Balme-les-Grottes, France) incubated at 37°C with 10% CO 2 developed scanty, buff-colored, rough colonies 2 weeks later. Microscopic examinations revealed short Gram-positive bacilli and acid-fast bacilli that formed clumps. Conventional biochemical reactions revealed a negative niacin test result and a positive nitrate reductase test result, suggesting that the acidfast bacilli were nontuberculous mycobacteria. Identific...

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“…Two of Kelly's patients with atypical tuberculous arthritis with no history of trauma had evidence of rheumatoid arthritis (5). Similarly, Klinenberg's patient was thought to have chronic rheumatoid arthritis and a history of trauma was equivocal (7). O u r patient had lupus arthritis and also suffered trauma via arthrocentesis and intraarticular injection to multiple joints.…”

Section: Discussionmentioning

confidence: 99%

“…Upon a background of immunologic compromise our patient's disease progressed from isolated pulmonary infection to monoarticular arthritis to polyarthritis with subcutaneous nodules. T h e 3 patients with rheumatoid arthritis in Kelly's series (5,7), the lymphopenic child reported by McCracken (3), the pancytopenic steroid-treated patients reviewed by Engstrom, and even Engstrom's previously healthy man who developed pancytopenia (1) represent cases of opportunistic M . kansasii dissemination in the compromised host.…”

Section: Discussionmentioning

confidence: 99%

Destructive polyarthritis secondary to mycobacterium kansasii

Girard

Bagby

Walsh

1973

Arthritis & Rheumatism

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A 42-year-old patient is reported in whom Mycobacterium kansasii pulmonary infection preceded the development of arthritis secondary to hematogenous spread. Contributing factors included systemic lupus erythematosus and corticosteroid therapy. Further, we present evidence that in M . kansasii infections, pulmonary lesions may precede extrapulmonary disease; hematogenous spread of infection likely represents the route through which joint disease evolves; previous damage to the joint whether from intrinsic disease as in rheumatoid arthritis, or extrinsic disease as in trauma, may be necessary for the development of infectious arthritis; and lastly, dissemination often represents opportunistic infection in patients who are immunologically compromised.Disease due to Mycobacterium kansasii has a predilection for middle-aged to elderly Caucasian men and is usually confined to the lungs. Although M. kansasii is believed to be less invasive than M. tuberculosis, it has caused meningitis as well as bone and joint, genitourinary, peritoneal, and disseminated disease. The latter has occurred most commonly in hosts who are immunologically compromised (1 -4).There is no evidence that M . kansasii infections are communicable or that their incidence is increased in alcoholic, diabetic, or socioeconomically depressed patients. T h e signs, symptoms, and roentgenographic and pathologic We report a case of a 42-year-old patient with systemic lupus erythematosus and pulmonary M. kansasii infection who developed destructive polyarthritis presumably secondary to hematogenous spread. CASE REPORT First HospitalizationA 42-year-old man entered the Portland Veterans Administration Hospital in October 1961 with hemoptysis of 6 months duration, anorexia, nightly fever (102" to 104"F), polyarthralgias involving multiple,joints of the hands, and a 25-pound weight loss of 2 months duration. Two weeks before admission he noted tenderness, swelling, and redness of the proximal interphalangeal joints of the right hand and, subsequently, of both elbows, shoulders, knees, ankles, and several toes.The patient was thin but not acutely ill. The proximal interphalangeal and metacarpophalangeal joints of both hands were erythematous, tender, and swollen. A "butterfly" malar rash was present.Hematocrit was 39%. reticulocyte count 2.5% white blood cell count 4,400 cells/cu mm with a normal differential count. The urinary sediment contained 20 to 30 red blood cells, 3 to 5 white blood cell casts, and an occasional

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Infection of Synovial Tissues by Mycobacteria Other than Mycobacterium tuberculosis

Cited by 99 publications

References 0 publications

Anomalous flexor digitorum superficialis muscle transposition for vascular coverage of the median nerve in recurrent carpal tunnel syndrome

Anomalous flexor digitorum superficialis muscle transposition for vascular coverage of the median nerve in recurrent carpal tunnel syndrome

Prosthetic Joint Infection Caused by Mycobacterium alvei in an Elderly Patient

Destructive polyarthritis secondary to mycobacterium kansasii

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