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Horseshoe abscess of the hand with rice bodies secondary to mycobacterium avium intracellulare infection

  • George R. Matcuk Jr
    Correspondence
    Corresponding author at: Department of Radiology, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite L1600, Los Angeles, CA 90033, United States of America.
    Affiliations
    Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
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  • Dakshesh B. Patel
    Affiliations
    Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
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  • Rachel E. Lefebvre
    Affiliations
    Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
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Published:February 26, 2020DOI:https://doi.org/10.1016/j.clinimag.2020.02.015

      Highlights

      • Hand infections are very common and prompt diagnosis and treatment are essential to minimize devastating complications.
      • The flexor tendon sheaths of the thumb and little finger communicate with the radial and ulnar bursae.
      • Mycobacterial infection should be considered with a history of corticosteroid or TNFi therapy or prior steroid injection.

      Abstract

      A horseshoe abscess is caused by infection that spreads between the flexor tendon sheath of the thumb or little finger through the radial and ulnar bursae through communication between the two and/or the space of Parona. We present a case of an 80-year-old woman with rheumatoid arthritis who presented with 6 months of right hand and wrist soft tissue swelling, initially treated as a rheumatoid arthritis flare. MRI demonstrates the horseshoe abscess and after surgical irrigation and debridement with synovectomy, cultures demonstrated infection with mycobacterium avium intracellulare (MAI). This case demonstrates the importance of MRI in diagnosing and evaluating the extent of hand infections and for considering mycobacterial organisms for appropriate treatment and antibiotic regimen.

      Graphical abstract

      Keywords

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      References

      1. Ong YS, Levin LS. Hand infections. Plast Reconstr Surg. 2009; 124(4):225e-233e.

        • Ouelett E.A.
        Infections.
        in: Light TR American Society of Surgery of the hand: hand surgery update 2. American Academy of Orthopaedic Surgeons, Rosemont, IL1999: 411-421
        • Patel D.B.
        • Emmanuel N.B.
        • Stevanovic M.V.
        • et al.
        Hand infections: anatomy, types and spread of infection, imaging findings, and treatment options.
        Radiographics. 2014; 34: 1968-1986
        • Aguiar R.O.
        • Gasparetto E.L.
        • Escuissato D.L.
        • et al.
        Radial and ulnar bursae of the wrist: cadaveric investigation of regional anatomy with ultrasonographic-guided tenography and MR imaging.
        Skeletal Radiol. 2006; 35: 828-832
        • Fussey J.M.
        • Chin K.F.
        • Gogi N.
        • Gella S.
        • Deshmukh S.C.
        An anatomic study of flexor tendon sheaths: a cadaveric study.
        J Hand Surg Eur Vol. 2009; 34: 762-765
        • Resnick D.
        Roentgenographic anatomy of the tendon sheaths of the hand and wrist: tenography.
        Am J Roentgenol Radium Ther Nucl Med. 1975; 124: 44-51
        • Sharma K.S.
        • Rao K.
        • Hobson M.I.
        Space of Parona infections: experience in management and outcomes in a regional hand centre.
        J Plast Reconstr Aesthet Surg. 2013; 66: 968-972
        • Stevanovic M.V.
        • Sharpe F.
        Acute infections.
        in: Hotchkiss RN Pederson WC Kozin SH eds Green’s operative hand surgery 6th ed Wolfe SW. Elsevier/Churchill Livingstone, Philadelphia2011: 41-84
        • Simon D.A.
        • Taylor T.L.
        Horseshoe abscess associated with acute carpal tunnel syndrome: somebody wake up the hand surgeon.
        CJEM. 2012; 14: 124-127
        • Gunther S.F.
        Infections of the hand.
        Introduction and overview. Instr Course Lect. 1990; 39: 527-531
        • Rigopoulos N.
        • Dailiana Z.H.
        • Varitimidis S.
        • Malizos K.N.
        Closed-space hand infections: diagnostic and treatment considerations.
        Orthop Rev (Pavia). 2012; 4e19
        • Franko O.I.
        • Abrams R.A.
        Hand infections.
        Orthop Clin North Am. 2013; 44: 625-634
      2. Kanavel AB. The symptoms, signs, and diagnosis of tenosynovitis and fascial-space abscesses. Infections of the Hand. 1st ed. ed. Philadelphia, PA: Lea & Febiger; 1912:201–226.

        • Winthrop K.L.
        • Yamashita S.
        • Beekmann S.E.
        • Polgreen P.M.
        Infectious Diseases Society of America Emerging Infections N. Mycobacterial and other serious infections in patients receiving anti-tumor necrosis factor and other newly approved biologic therapies: case finding through the Emerging Infections Network.
        Clin Infect Dis. 2008; 46: 1738-1740
        • Winthrop K.L.
        • Chang E.
        • Yamashita S.
        • Iademarco M.F.
        • LoBue P.A.
        Nontuberculous mycobacteria infections and anti-tumor necrosis factor-alpha therapy.
        Emerg Infect Dis. 2009; 15: 1556-1561
        • Shah N.
        • Mulgrew S.
        • Laing T.
        Acute horseshoe abscess of the hand after corticosteroid injection to treat trigger thumb.
        BMJ Case Rep. 2018; 2018
        • Olesen J.S.
        • Wang M.
        • Wejse C.
        Mycobacterium chelonae hand infection after steroid injection in a patient with rheumatoid arthritis receiving long-term linezolid therapy.
        BMJ Case Rep. 2017; 2017
        • Weber E.
        • Gagneux-Brunon A.
        • Jacomo V.
        • Rousselon T.
        • Lucht F.
        • Botelho-Nevers E.
        Tenosynovitis: a rare presentation of tuberculosis better known by hand surgeons than infectious diseases specialists.
        Infection. 2015; 43: 261-266
        • Sbai M.A.
        • Benzarti S.
        • Boussen M.
        • Maalla R.
        Tuberculous flexor tenosynovitis of the hand.
        Int J Mycobacteriol. 2015; 4: 347-349
        • Zenone T.
        • Boibieux A.
        • Tigaud S.
        • et al.
        Non-tuberculous mycobacterial tenosynovitis: a review.
        Scand J Infect Dis. 1999; 31: 221-228
        • Neviaser R.J.
        Tenosynovitis.
        Hand Clin. 1989; 5: 525-531
        • Chan E.
        • Bagg M.
        Atypical hand infections.
        Orthop Clin North Am. 2017; 48: 229-240
        • Kozin S.H.
        • Bishop A.T.
        Atypical Mycobacterium infections of the upper extremity.
        J Hand Surg Am. 1994; 19: 480-487
        • Hellinger W.C.
        • Smilack J.D.
        • Greider Jr., J.L.
        • et al.
        Localized soft-tissue infections with Mycobacterium avium/Mycobacterium intracellulare complex in immunocompetent patients: granulomatous tenosynovitis of the hand or wrist.
        Clin Infect Dis. 1995; 21: 65-69
      3. Darrow M, Foulkes G, Richmann PN, de los Reyes CL, Floyd WE, 3rd. Deep infection of the hand with Mycobacterium avium-intracellulare: two case reports. Am J Orthop (Belle Mead NJ). 1995; 24(12):914–917.

        • Hide M.
        • Hondo T.
        • Yonehara S.
        • Motohiro Y.
        • Okano S.
        Infection with Mycobacterium avium-intracellulare with abscess, ulceration and fistula formation.
        Br J Dermatol. 1997; 136: 121-123
        • Lefevre P.
        • Gilot P.
        • Godiscal H.
        • Content J.
        • Fauville-Dufaux M.
        Mycobacterium intracellulare as a cause of a recurrent granulomatous tenosynovitis of the hand.
        Diagn Microbiol Infect Dis. 2000; 38: 127-129
        • Anim-Appiah D.
        • Bono B.
        • Fleegler E.
        • Roach N.
        • Samuel R.
        • Myers A.R.
        Mycobacterium avium complex tenosynovitis of the wrist and hand.
        Arthritis Rheum. 2004; 51: 140-142
        • Noguchi M.
        • Taniwaki Y.
        • Tani T.
        Atypical Mycobacterium infections of the upper extremity.
        Arch Orthop Trauma Surg. 2005; 125: 475-478
        • Vuppalapati G.
        • Turner A.
        • La Rusca I.
        • Schonauer F.
        Mycobacterium avium infection involving skin and soft tissue of the hand treated by radical debridement and reconstruction in addition to multidrug chemotherapy.
        J Hand Surg Br. 2006; 31: 693-694
        • Saraya T.
        • Fukuoka K.
        • Maruno H.
        • et al.
        Tenosynovitis with rice body formation due to Mycobacterium intracellulare infection after initiation of infliximab therapy.
        Am J Case Rep. 2018; 19: 656-662
        • Balague N.
        • Uckay I.
        • Vostrel P.
        • Hinrikson H.
        • Van Aaken I.
        • Beaulieu J.Y.
        Non-tuberculous mycobacterial infections of the hand.
        Chir Main. 2015; 34: 18-23
        • Aburjania N.
        • Hammert W.C.
        • Bansal M.
        • Boyce B.F.
        • Munsiff S.S.
        Chronic tenosynovitis of the hand caused by Mycobacterium heraklionense.
        Int J Mycobacteriol. 2016; 5: 273-275
      4. Lekic N, Rosenberg AE, Askari M. Mycobacterium longobardum Infection in the Hand. J Hand Surg Am. 2018; 43(5):491 e491–491 e494.

        • Omoruyi O.J.
        • Ip W.Y.
        • To KK
        Hand infection due to Mycobacterium neoaurum.
        J Hand Surg Eur Vol. 2012; 37: 574-575
        • Beam E.
        • Vasoo S.
        • Simner P.J.
        • et al.
        Mycobacterium arupense flexor tenosynovitis: case report and review of antimicrobial susceptibility profiles for 40 clinical isolates.
        J Clin Microbiol. 2014; 52: 2706-2708
        • Soldatos T.
        • Omar H.
        • Sammer D.
        • Chhabra A.
        Atypical infections versus inflammatory conditions of the hand: the role of imaging in diagnosis.
        Plast Reconstr Surg. 2015; 136: 316-327
        • Coombes G.M.
        • Teh L.S.
        • Denton J.
        • Johnson A.S.
        • Jones A.K.
        Mycobacterium xenopi--an unusual presentation as tenosynovitis of the wrist in an immunocompetent patient.
        Br J Rheumatol. 1996; 35: 1008-1010
        • Rodari P.
        • Marocco S.
        • Buonfrate D.
        • et al.
        Prosthetic joint infection due to Mycobacterium xenopi: a review of the literature with a new case report.
        Infection. 2019; (Advance online publication)https://doi.org/10.1007/s15010-019-01318-1
        • Nakano N.
        • Wada R.
        • Yajima N.
        • Yamamoto N.
        • Wakai Y.
        • Otsuka H.
        Mycobacterial infection of the musculoskeletal tissues: the use of pathological specimens for identification of causative species by PCR-direct sequencing of 16S rDNA.
        Jpn J Infect Dis. 2010; 63: 188-191