Osteomyelitis of the wrist caused by Mycobacterium arupense in an immunocompetent patient: a unique case

Abstract

Osteomyelitis of the wrist caused by Mycobacterium arupense in an immunocompetent patient: a unique case Mycobacterium arupense, a slow-growing Mycobacterium, was first isolated from clinical samples in 2006 by Cloud et al. 1 and in water by another team. 2 Two cases of tenosynovitis have recently been reported. 3,4 We report here the first case of osteomyelitis of the wrist caused by M. arupense following a penetrating injury to the hand.In December 2008, a 35-year-old patient without any significant medical history presented with progressive swelling and pain of the left wrist. Eight months earlier, he had cut the flexor tendons of his left hand with a glass filled with mud. An X-ray of the wrist showed a narrow joint space and two cortical erosions. Echography revealed an abscess extending to the dorsal face of the wrist. A synovectomy was performed. Both site cultures for common bacteria and Mycobacterium were negative. Pathological examination revealed granulomatous inflammation with Langhans giant cells. Because of the progressive pain in the wrist, a corticosteroid injection was performed, but did not alleviate the pain.In May 2010, an X-ray of the wrist showed multiple erosions. An arthrodesis was performed. M. arupense was identified by sequencing of hsp65 and 16S rRNA genes and on culture. The patient then received clarithromycin (1000 mg daily), rifabutin (300 mg daily), and ethambutol (1000 mg daily). Rifabutin was discontinued after 2 weeks because of liver disorders. The patient was treated with clarithromycin-ciprofloxacin (1500 mg/day) for 12 months.

Mycobacterium arupense, Mycobacterium heraklionense, and a Newly Proposed Species, “Mycobacterium virginiense” sp. nov., but Not Mycobacterium nonchromogenicum, as Species of the Mycobacterium terrae Complex Causing Tenosynovitis and Osteomyelitis

“…There have been approximately 34 additional case reports published since then, identified using nonmolecular methods , with 14 cases identified using molecular methods (26)(27)(28)(30)(31)(32)(33)(34)(35)(36) (Tables 1 and 2). With the exception of four isolates of M. arupense, including the original description of M. arupense (28), details of the methods and/or explicitly stating a 100% 16S rRNA gene sequence identity to recognized species for the remaining cases with molecular identifications have been absent (Table 2).…”

Draft Genome Sequence of Mycobacterium arupense Strain GUC1

“…Mycobacterium arupense is a rapidly growing nonchromogenic mycobacteria that is closely related to the Mycobacterium terrae complex and has been isolated from clinical samples, most commonly sputum samples, as well as environmental water sources ( 1 – 3 ). Multiple reports of tenosynovitis and osteoarticular infections with M. arupense have also been presented, including infections caused by the type strain AR30097 ( 4 – 8 ). Although the unique identification of M. arupense has generally been related to sequence analysis, the phenotypic properties of M. arupense that resulted in it being classified as a species include its inability to grow at 42°C, rapid growth at 30°C, variable pyrazinamidase activity, and mycolic acid patterns that distinguish it from M. terrae ( 1 ).…”

First Korean Case of Mycobacterium arupense Tenosynovitis

“…Although the clinical significance of M. arupense is controversial, infections caused by this organism are occasionally reported [10, 11, 12, 13, 14]. To date, only 6 patients, besides the present case, have been infected with M. arupense , although 1 pulmonary isolate from an immunocompetent patient was classified as colonization according to the American Thoracic Society criteria [6].…”

“…Although the M. terrae complex is generally considered nonpathogenic [6], infections caused by the M. terrae complex have been reported [7, 8, 9]. The pathogenicity of M. arupense is debatable, but a few cases of M. arupense infection involving bacteremia, osteomyelitis, pulmonary infection, and tenosynovitis have been reported [10, 11, 12, 13, 14]. We report a case of M. arupense tenosynovitis in a patient with a history of puncture injury to the finger caused by a crab.…”