Chronic Tenosynovitis of the Upper Extremities Caused by Mycobacterium kansasii: A Clinical Case and Systematic Review of LiteratureFunding Source This study was supported in part by the Mayo Clinic Center for Individualized Medicine and the Plastic Surgery Foundation.
06 April 2020 (online)
Background Chronic tenosynovitis of the upper extremities caused by Mycobacterium kansasii (M. kansasii) is uncommon, but symptoms may overlap with other more common diseases. Late diagnosis and treatment can lead to disfiguration of structures and rupture of tendons, resulting in worse cosmetic outcomes after reconstruction.
Methods We present a clinical case and literature review of M. kansasii in patients with chronic tenosynovitis of upper extremities. PubMed was queried for cases of upper extremities tenosynovitis caused by M. kansasii. The keywords “M. kansasii,” “tenosynovitis” and synonyms were used for search in different combinations. Manuscripts, with no specific data or another condition, where the infection was not located in the upper extremities, were reviews, or not in English, were excluded from the study.
Results We described 23 reported cases of tenosynovitis of the upper extremity caused by M. kansasii. An immunosuppressed state was present in eight (34.8%) cases, and 12 (52.2%) patients received immunosuppressive treatment. A long-time period between the first appearance of symptoms and the definitive diagnosis was identified (median: 7 months, interquartile range: 9). The most frequent symptoms were local swelling (65.2%), pain (56.5%), mass effect (26%), and stiffness (13%). Tendon rupture was found in three (13%) patients as a complication of the disease. Moreover, seven (30.4%) patients underwent previous surgeries to try to relieve the symptoms before definitive diagnosis was achieved.
Conclusion M. kansasii is an important differential causal pathogen for tenosynovitis of the upper extremities. Although rare, raising awareness about this infectious disease is imperative to avoid inadequate management and hazardous aesthetic sequelae.
- 1 Chan A, Findlay A, Abeygunasekara S. A case of wrist tenosynovitis caused by Mycobacterium kansasii in a renal transplant recipient. Transpl Infect Dis 2012; 14 (05) E44-E49
- 2 Johnston JC, Chiang L, Elwood K. Mycobacterium kansasii. Microbiol Spectr 2017; 5 (01) 5
- 3 Balagué N, Uçkay I, Vostrel P, Hinrikson H, Van Aaken I, Beaulieu JY. Non-tuberculous mycobacterial infections of the hand. Chir Main 2015; 34 (01) 18-23
- 4 Zenone T, Boibieux A, Tigaud S. et al. Non-tuberculous mycobacterial tenosynovitis: a review. Scand J Infect Dis 1999; 31 (03) 221-228
- 5 Mazis GA, Sakellariou VI, Kontos F, Zerva L, Spyridonos SG. Recurrent fluctuant mass of the wrist and forearm associated with chronic tenosynovitis by Mycobacterium kansasii. Orthopedics 2011; 34 (05) 400
- 6 Dillon J, Millson C, Morris I. Mycobacterium kansasii infection in the wrist and hand. Br J Rheumatol 1990; 29 (02) 150-153
- 7 Mejia H, Ryzewicz M, Scott F. Trigger finger due to tenosynovitis from Mycobacterium kansasii infection in an immunocompetent patient. Orthopedics 2007; 30 (12) 1055-1056
- 8 Wang MS, Berry M, Lehto-Hoffman A, Vi L, Ramessar N. Chronic tenosynovitis due to Mycobacteria kansasiiin an immunocompetent host. Case Rep Infect Dis 2018; 2018: 3297531
- 9 Kozin SH, Bishop AT. Atypical Mycobacterium infections of the upper extremity. J Hand Surg Am 1994; 19 (03) 480-487
- 10 Lidar M, Elkayam O, Goodwin D, Yaron M, Caspi D. Protracted Mycobacterium kansasii carpal tunnel syndrome and tenosynovitis. Isr Med Assoc J 2003; 5 (06) 453-454
- 11 Gerster JC, Duvoisin B, Dudler J, Berner IC. Tenosynovitis of the hands caused by Mycobacterium kansasii in a patient with scleroderma. J Rheumatol 2004; 31 (12) 2523-2525
- 12 Southern Jr PM. Tenosynovitis caused by Mycobacterium kansasii associated with a dog bite. Am J Med Sci 2004; 327 (05) 258-261
- 13 Lorenz HM, Dalpke AH, Deboben A. et al. Mycobacterium kansasii tenosynovitis in a rheumatoid arthritis patient with long-term therapeutic immunosuppression. Arthritis Rheum 2008; 59 (06) 900-903
- 14 Formanoy E, Lam HY, Arends JE. Tenosynovitis of the right handMycobacterium kansasii . Neth J Med 2013; 71 (10) 526-530
- 15 Sanger JR, Stampfl DA, Franson TR. Recurrent granulomatous synovitis due to Mycobacterium kansasii in a renal transplant recipient. J Hand Surg Am 1987; 12 (03) 436-441
- 16 Wada A, Nomura S, Ihara F. Mycobacterium kansasiiflexor tenosynovitis presenting as carpal tunnel syndrome. J Hand Surg [Br] 2000; 25 (03) 308-310
- 17 Rust PA, Bennett T. An uncommon cause for a common complaint. Hand Surg 2009; 14 (2-3) 131-134
- 18 Jing SS, Teare L, Iwuagwu F. Mycobacterium kansasii flexor tenosynovitis of the finger. Hand Surg 2014; 19 (02) 249-251
- 19 Leader M, Revell P, Clarke G. Synovial infection with Mycobacterium kansasii. Ann Rheum Dis 1984; 43 (01) 80-82
- 20 Dorff GJ, Frerichs L, Zabransky RJ, Jacobs P, Spankus JD. Musculoskeletal infections due to Mycobacterium kansasii . Clin Orthop Relat Res 1978; (136) 244-246
- 21 Campbell IA, Ormerod LP. “Opportunist” mycobacterial infections. Thorax 2000; 55 (08) 722
- 22 Saraya T, Fukuoka K, Maruno H. et al. Tenosynovitis with rice body formation due to mycobacterium intracellular infection after initiation of infliximab therapy. Am J Case Rep 2018; 19: 656-662
- 23 Yano K, Yoshida T, Minoda Y. et al. Clinical outcome of the chronic flexor tenosynovitis in the hand caused by non-tuberculous mycobacterium treated by extensive tenosynovectomy and drugs. J Plast Surg Hand Surg 2013; 47 (06) 434-437