The Journal of Foot & Ankle Surgery 53 (2014) 350–352
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The Journal of Foot & Ankle Surgery journal homepage: www.jfas.org
Achilles Tendon Infection Due to Mycobacterium chelonae Tun Hing Lui, MBBS (HK), FRCS (Edin), FHKAM, FHKCOS 1, Kwok Bill Chan, MBBS (HK), FRCSEd (Ortho), FHKAM, FHKCOS 2 1 2
Consultant, Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China Associate Consultant, Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China
a r t i c l e i n f o
a b s t r a c t
Level of Clinical Evidence: 4
Atypical tuberculous tenosynovitis of the foot and ankle is extremely rare. The determination of the Mycobacterium species is essential because resistance of atypical mycobacterial strains to antituberculous drugs is often encountered. We report a case of Mycobacterium chelonae paratendinous and intratendinous infection involving the Achilles tendon. Repeat aggressive irrigation and debridement procedures, coupled with removal of foreign materials and the appropriate use of prolonged antibiotic therapy, can result in a successful long-term outcome. Ó 2014 by the American College of Foot and Ankle Surgeons. All rights reserved.
Keywords: atypical tuberculous tenosynovitis infection Mycobacteriaciae tendoAchillis
Atypical tuberculous tenosynovitis is a rare clinical entity, and the peak occurrence of this condition has been during the fourth and seventh decades of life in immunocompetent individuals (1). It will most commonly involve the tendon sheaths of the hand and wrist and has been seldom reported in the foot and ankle (2). The pathogenesis of tenosynovitis is either by direct inoculation or hematogenous spread from a previous site of infection. In a Mayo Clinic study (3), 44% of the patients had had other sites of involvement, most commonly lung, kidney, and spinal involvement, and approximately one half of the patients had reported a previous exposure to tuberculosis. Local trauma before infection was reported in one third of the cases (2,3). A number of other reports have described soft tissue, joint, and tendon infections due to tubercular and similar organisms, involving the foot and ankle (4–7). In the present report, we have described the rare case of a young male who experienced infectious tendoAchillis tenosynovitis (more accurately, paratendinitis, because the Achilles tendon is not surrounded by a synovial sheath) due to Mycobacterium chelonae. Case Report A 20-year-old male bartender had had his right heel lacerated by broken glass in November 2008. Exploration of the wound was performed on the same date of injury and revealed complete laceration of the Achilles tendon with mild wound contamination and no foreign Financial Disclosure: None reported. Conflict of Interest: None reported. Address correspondence to: Tun Hing Lui, MBBS (HK), FRCS (Edin), FHKAM, FHKCOS, Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China. E-mail address: [email protected] (T.H. Lui).
body. Wound debridement, tendon repair with no. 2 nonabsorbable, multifilament, polyester suture (EthibondÒ, Ethicon, a Division of Johnson & Johnson, Somerville, NJ), and wound closure was performed. No drain was inserted into the wound. Postoperatively, a small amount (
Contents lists available at ScienceDirect
The Journal of Foot & Ankle Surgery journal homepage: www.jfas.org
Achilles Tendon Infection Due to Mycobacterium chelonae Tun Hing Lui, MBBS (HK), FRCS (Edin), FHKAM, FHKCOS 1, Kwok Bill Chan, MBBS (HK), FRCSEd (Ortho), FHKAM, FHKCOS 2 1 2
Consultant, Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China Associate Consultant, Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China
a r t i c l e i n f o
a b s t r a c t
Level of Clinical Evidence: 4
Atypical tuberculous tenosynovitis of the foot and ankle is extremely rare. The determination of the Mycobacterium species is essential because resistance of atypical mycobacterial strains to antituberculous drugs is often encountered. We report a case of Mycobacterium chelonae paratendinous and intratendinous infection involving the Achilles tendon. Repeat aggressive irrigation and debridement procedures, coupled with removal of foreign materials and the appropriate use of prolonged antibiotic therapy, can result in a successful long-term outcome. Ó 2014 by the American College of Foot and Ankle Surgeons. All rights reserved.
Keywords: atypical tuberculous tenosynovitis infection Mycobacteriaciae tendoAchillis
Atypical tuberculous tenosynovitis is a rare clinical entity, and the peak occurrence of this condition has been during the fourth and seventh decades of life in immunocompetent individuals (1). It will most commonly involve the tendon sheaths of the hand and wrist and has been seldom reported in the foot and ankle (2). The pathogenesis of tenosynovitis is either by direct inoculation or hematogenous spread from a previous site of infection. In a Mayo Clinic study (3), 44% of the patients had had other sites of involvement, most commonly lung, kidney, and spinal involvement, and approximately one half of the patients had reported a previous exposure to tuberculosis. Local trauma before infection was reported in one third of the cases (2,3). A number of other reports have described soft tissue, joint, and tendon infections due to tubercular and similar organisms, involving the foot and ankle (4–7). In the present report, we have described the rare case of a young male who experienced infectious tendoAchillis tenosynovitis (more accurately, paratendinitis, because the Achilles tendon is not surrounded by a synovial sheath) due to Mycobacterium chelonae. Case Report A 20-year-old male bartender had had his right heel lacerated by broken glass in November 2008. Exploration of the wound was performed on the same date of injury and revealed complete laceration of the Achilles tendon with mild wound contamination and no foreign Financial Disclosure: None reported. Conflict of Interest: None reported. Address correspondence to: Tun Hing Lui, MBBS (HK), FRCS (Edin), FHKAM, FHKCOS, Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China. E-mail address: [email protected] (T.H. Lui).
body. Wound debridement, tendon repair with no. 2 nonabsorbable, multifilament, polyester suture (EthibondÒ, Ethicon, a Division of Johnson & Johnson, Somerville, NJ), and wound closure was performed. No drain was inserted into the wound. Postoperatively, a small amount (
