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Mycobacterial avium intracellulare (MAI) extensor tenosynovitis of wrist: An uncommon entity.

Radiol Case Rep

February 2025

Department of Medical Imaging,St. Joseph's Health Care London, 268 Grosvenor St, London, Ontario, Canada, N6A 4V2.

Rice bodies secondary to synovial inflammation, typically occur in the shoulders and knees of individuals affected by either rheumatoid arthritis or tuberculosis. It is uncommon to encounter these in nontubercular mycobacterial tenosynovitis especially in wrist extensor compartment. Understanding this condition and its distinctive imaging features is crucial for both treating clinicians and radiologists.

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Objectives: Nontuberculous mycobacteria (NTM) bone and joint infections (BJIs) are uncommon. We evaluated the characteristics of BJIs and identified differences according to immune status.

Methods: We performed a multicenter retrospective study in France involving patients with documented NTM BJI over a 9-year period.

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Nontuberculous mycobacteria (NTM) are uncommon causes of cutaneous and musculoskeletal infections. Here, we present an immunocompromised patient with persistent swelling in the left hand, wrist, and distal forearm. MRI findings revealed flexor tenosynovitis with synovial hypertrophy of the left hand and wrist and loculated fluid containing rice bodies along the distal flexor digitorum muscles in the volar aspect of the left wrist.

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Case: A 36-year-old female healthcare worker with no past medical history, accidentally injected her flexed right middle finger with live attenuated bacillus Calmette-Guérin (BCG). Swelling and erythema around the injured area appeared two days after the needlestick injury. She was referred to the hospital and presented approximately nine days after self-inoculation.

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Article Synopsis
  • Mycobacterium haemophilum (MH) is a slow-growing bacterium primarily affecting immunocompromised individuals, often leading to skin infections that can either be isolated or widespread.
  • A review of 79 cases from 2011-2022 found common skin manifestations such as nodules, ulcers, and abscesses, particularly in middle-aged patients taking immunosuppressive medications.
  • Treatment generally lacks strong guidelines, but a combination of quinolone, macrolides, and rifampicin is commonly used, and while the prognosis is generally good, specific factors like iatrogenic immunosuppression and proximal limb lesions can worsen outcomes.
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