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Nontuberculous Mycobacterial Osteomyelitis of the Thumb: Successful Treatment with Serial Debridement, Antimicrobial Therapy, External Fixation, and Interphalangeal Arthrodesis

A Case Report

Ehrlichman, Lauren K., MD1; Kadzielski, John J., MD1; Hyle, Emily P., MD1; Jupiter, Jesse B., MD1

doi: 10.2106/JBJS.CC.N.00245
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Case: We present the case of a fifty-seven-year-old woman treated for persistent inflammation of her thumb initially thought to be due to tuberculous osteomyelitis but which ultimately proved to be due to infection caused by a novel nontuberculous mycobacterial species. The establishment of this diagnosis and her treatment are described.

Conclusion: Indolent hand infections caused by atypical mycobacterial species may occur even in immunocompetent hosts, and their diagnosis remains challenging and often elusive. Surgeons should have a low threshold of suspicion for nontuberculous mycobacteria in cases refractory to treatment by standard protocols. The miniature external fixator provides stability and allows for soft-tissue healing in the setting of hand infections.

1Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail address for L.K. Ehrlichman: lehrlichman@partners.org

Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated
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