title: Acute mycobacterial flexor tenosynovitis following accidental bacillus calmette-guérin inoculation in a health care worker: case report.
abstract: Solutions containing bacillus Calmette-Guérin (BCG), a live attenuated form of Mycobacterium bovis or Mycobacterium tuberculosis, commonly are injected intravesically to treat tumors of the urinary bladder. We report a case of acute mycobacterial flexor tenosynovitis in a health care worker who inadvertently inoculated her finger via needlestick while preparing BCG solution for intravesicular administration. She was treated successfully with immediate operative intervention followed by 6 months of antimycobacterial antibiotics. Of 3 previous reports of hand infections following self-inoculation with BCG solutions, this case is unique owing to rapid onset of acute mycobacterial flexor tenosynovitis and positive intraoperative mycobacterial cultures. Needlesticks with BCG-containing solutions, especially into the flexor tendon sheath, should be treated with timely surgical debridement and appropriate antimycobacterial management.
authors.affiliation: Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland 21218, USA.
authors.forename: Gerhard S
authors.initials: GS
authors.lastname: Mundinger
authors.forename: Keith C
authors.initials: KC
authors.lastname: Douglas
authors.forename: James P
authors.initials: JP
authors.lastname: Higgins
mesh_terms: D000208:Acute Disease; D000283:Administration, Intravesical; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001500:BCG Vaccine / Q000008:administration & dosage* / Q000009:adverse effects*; D003131:Combined Modality Therapy; D005260:Female; D005383:Finger Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D009164:Mycobacterium Infections / Q000175:diagnosis* / Q000601:surgery; D009163:Mycobacterium bovis; D016602:Needlestick Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D009784:Occupational Diseases / Q000175:diagnosis* / Q000601:surgery; D011182:Postoperative Care; D013710:Tendons / Q000601:surgery; D013717:Tenosynovitis / Q000175:diagnosis* / Q000601:surgery
chemical_list: D000995:Antitubercular Agents; D001500:BCG Vaccine