title: Clinical features and treatment outcomes of septic arthritis due to Mycobacterium massiliense associated with intra-articular injection: a case report.
abstract: BACKGROUND
  There are increasing reports on nosocomial Mycobacterium massiliense infection, but septic arthritis and osteomyelitis because of that microorganism is rare. This report focuses on the clinical aspects of M. massiliense arthritis outbreak concurrent with soft tissue infection.
  
  
  METHODS
  An outbreak of septic arthritis among patients who had been injected at a single clinic occurred in South Korea between April and September 2012. This may be associated with repeated injection of triamcinolone contaminated with M. massiliense. Nine of the Korean patients visited our hospital complaining of painful swelling of the knees. During treatment course, patients are suffered from soft tissue abscess around the injection site. Acid-fast bacilli culture for infected tissue was positive in five patients, and polymerase chain reaction for non-tuberculous mycobacteria was positive in four patients. They were treated with antibiotics, repeated arthroscopic surgeries, incision and drainage for a long time. All patients were eventually cured but three patients have suffered from a decreased range of motion.
  
  
  CONCLUSIONS
  Early clinical suspicion and microbiological diagnosis are key factors in reducing morbidity since septic arthritis with M. massiliense manifests late after the injection and treatment of it is a laborious process.
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, Korea.
authors.forename: Haekyung
authors.initials: H
authors.lastname: Lee
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, Korea.
authors.forename: Dohui
authors.initials: D
authors.lastname: Hwang
authors.affiliation: Department of Orthopedic Surgery, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, Korea.
authors.forename: Minchul
authors.initials: M
authors.lastname: Jeon
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, Korea. shegets@schmc.ac.kr.
authors.forename: Eunjung
authors.initials: E
authors.lastname: Lee
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, Korea.
authors.forename: Taehyong
authors.initials: T
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Soonchunhyang University Hospital, 17 Soonchunhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do, Korea.
authors.forename: Shi Nae
authors.initials: SN
authors.lastname: Yu
authors.affiliation: Department of Orthopedic Surgery, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, Korea.
authors.forename: Yongbeom
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, Korea.
authors.forename: Byung-Ill
authors.initials: BI
authors.lastname: Lee
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D004340:Drug Contamination; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular / Q000009:adverse effects; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D009161:Mycobacterium; D009164:Mycobacterium Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D056910:Republic of Korea / Q000453:epidemiology; D014221:Triamcinolone / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D014221:Triamcinolone
keywords: Case report; Intra-articular injection; Mycobacterium massiliense; Non-tuberculous mycobacteria; Septic arthritis