Mycobacterium chelonae Wrist Infection in an Immunocompetent Patient: 病例報告: 在一個免疫力正常患者出現的龜分枝桿菌手腕感染

We report a 48-year-old Chinese immunocompetent female who presented with right wrist pain and swelling for 9 months because of Mycobacterium chelonae infection of her right wrist. M. chelonae infection has been increasingly reported. Immunocompromised patients are at increased risk of developing such an infection, however, this occasionally occurs in immunocompetent patients. M. chelonae infection more commonly causes cutaneous or soft tissue infection; however, in our case, we found that the infection was so severe that the infective tenosynovial tissue from the volar side of the wrist had eroded through both the volar and dorsal cortex of the distal radius. To our knowledge, wrist tenosynovitis with osteomyelitis of the distal radius caused by M. chelonae is rarely reported, especially in an immunocompetent nontraumatic individual. We successfully treated this patient by repeated surgical debridement using different approaches, appropriate antibiotics, as well as application of antibiotic-loaded cement to fill the bone defect.

中 文 摘 要我們報告一位48歲免疫力正常的中國藉女性患者，因為龜分枝桿菌感染而導致右手手腕腫痛達九個月之久。有關龜分枝桿菌感染的報告在增加。免疫功能不足的患者會有較高的機會感染，但它也可感染免疫力正常的患者。龜分枝桿菌感染常見導致皮膚及軟組織的感染，但在這案例中，我們發現感染嚴重引致橈骨遠端掌側的感染組織侵蝕穿過橈骨遠端背側的骨皮質。就我們所見，龜分枝桿菌感染而導致手腕腱鞘炎和橈骨遠端側侵蝕的案例很少被報告過，特別是在一個免疫力正常、無創傷病歷的患者中。我們成功用不同途徑的清創手術、適當的抗生素、以及以抗生素混合骨水泥填補骨缺陷的方法治療好患者。