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

  • George R. Matcuk Jr
    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.
    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
    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
    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:


      • 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.


      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


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