Atypical mycobacterial infections of the hand: report of eight cases and literature review.

INTRODUCTION: Atypical mycobacteria are an uncommon cause of hand infections in immunocompetent patients. Diagnosis is often delayed, with consequent increased morbidity. Better awareness would allow earlier diagnosis and treatment.

MATERIAL AND METHODS: Eight patients with atypical mycobacterial hand infections treated in our department over a 21 year period have been retrospectively identified. Their charts have been searched for the general characteristics of these infections, treatment and outcome. Our findings have been compared to the data collected from a literature review.

RESULTS: These pathogens have caused soft tissue infections in otherwise healthy patients. Clinical signs were those of chronic finger or wrist synovitis or skin granulomas. Carpal tunnel syndrome was a common finding. Diagnosis relied on surgical biopsy. Germ identification required specific incubation temperature and media. Antibiotics and synovectomy have been the mainstay of therapy.

DISCUSSION: In a patient with achronic, relapsing, superficial or deep skin infection or tenosynovitis, aquatic and farm exposures are important anamnestic keys to diagnosis. Extensive synovectomy is both diagnostic and therapeutic. Specific cultures should be ordered without delay. Oral pharmacotherapy should be initiated upon clinical suspicion.