[Severe course of a rare non-tuberculous Mycobacteriosis (M. haemophilum) of the hand - case report and strategic comments].
BACKGROUND
Mycobacterium haemophilum belongs to the group of atypical mycobacteria and is rarely reported as a cause of upper extremity and hand infections. It is of low virulence. The bacterium seems to be ubiquitous. Sources and mechanism of infection are poorly defined.


METHODS
A 48-year-old female patient was admitted with chronic flexor tendon synovitis of the left palm and distal forearm site. Three debridements were carried out and wound swabs were taken. No proof of bacterial colonisation was found. Histologically a granulomatous infection with Langerhans cells was revealed. Effectively calculated monotherapy with ciprofloxacin was begun. Six weeks postoperatively Mycobacterium haemophilum was cultivated in a colaboration with the National Reference Centre for Mycobacteria in Borstel. Medication was changed to triple therapy with clarithromycin, ethambutol and rifabutin. The patient could carry out her daytime job three months postoperatively. One year after first admission functional impairment needed to be treated by scar excision and radical flexor tendon tendolysis. The palmar defect was resurfaced by using a transmetacarpal DMCA 2 flap at the same time. An almost full range of motion was achieved with intensive hand and physiotherapy after a total treatment period of 15 months.


CONCLUSIONS
Patients with upper extremity infections caused by atypical Mycobacteria need qualified hand-surgical care. The decision about need and kind of medicamentous treatment is based on germ differentiation and should be made in cooperation with the National Reference Centre for Mycobacteria in Borstel. To shorten the diagnostic gap between first admission and detection of Mycobacteria in hand infections with a non-typical course of disease we suggest a standardised approach.
Schumacher
O
O
Die Institutsangaben sind am Ende des Beitrags gelistet. oschum@yahoo.de
Dabernig
J
J
Nenadic
I
I
Ingianni
G
G
Cedidi
C
C
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use; D003646:Debridement; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000382:microbiology / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D018393:Mycobacterium haemophilum / Q000302:isolation & purification; D017828:Rifabutin / Q000008:administration & dosage / Q000627:therapeutic use; D013585:Synovitis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D017828:Rifabutin; D002939:Ciprofloxacin; D004977:Ethambutol; D017291:Clarithromycin