Tuberc Respir Dis.  2012 Feb;72(2):191-196.

A Case of Chronic Arthritis Due to Mycobacterium intracellulare after Trauma

• Kim JG
• Kim DW
• Cho YH
• Yim SM
• Kang JH
• Joo YB
• Kang HH
• Song JS
• Yoon HK

Abstract

While nontuberculous mycobacterium (NTM) infections are recently on the rise, arthritis caused by NTM is hardly reported in Korea. NTM arthritis has no distinctive clinical characteristics from chronic arthritis. Tuberculosis of the joint specifically produces similar clinical and pathologic presentations to NTM arthritis, so it is not easy to distinguish between them. We report a case of Mycobacterium intracellulare in an arthritis patient after trauma and surgical repair of the injury. At the beginning, the patient was diagnosed as tuberculous tenosynovitis through pathology without microbiologic evidence. The final diagnosis was made after subsequent recurrences for several years. The misdiagnosis and delayed diagnosis led to irreversible joint destruction and functional impairment. NTM infection must be included in the differential diagnosis of chronic arthritis at the outset.

Keyword

Arthritis; Mycobacterium avium-intracellulare Infection; Wounds and Injuries

MeSH Terms

Arthritis
Delayed Diagnosis
Diagnosis, Differential
Diagnostic Errors
Humans
Joints
Korea
Mycobacterium
Mycobacterium avium Complex
Mycobacterium avium-intracellulare Infection
Nontuberculous Mycobacteria
Recurrence
Tenosynovitis
Tuberculosis

Figure

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  Figure 1 Radiograph in anteroposterior (A) and medial oblique (B) projection of left wrist reveals arthrodesis state of radiocarpal and carpometacarpal joint with marked collapse and fusion in the carpal bones (hollow arrows). Distal ulna shows bony erosion and destruction (white arrows).

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  Figure 2 Histologic examination of excised soft tissue of left wrist shows chronic granulomatous inflammation with caseous necrosis (hollow arrows) and multinucleated giant cells (white arrow, H&E stain, ×100).

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