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
Graphical Abstract
Keywords
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Article info
Publication history
Published online: February 26, 2020
Accepted:
February 25,
2020
Received in revised form:
February 4,
2020
Received:
October 5,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
