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Kim, Kim, Cho, Yim, Kang, Joo, Kang, Song, and Yoon: A Case of Chronic Arthritis Due to Mycobacterium intracellulare after Trauma
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2012; 72(2): 191-196.

Published online: 29 February 2012

DOI: https://doi.org/10.4046/trd.2012.72.2.191

A Case of Chronic Arthritis Due to Mycobacterium intracellulare after Trauma

Jae Gyung Kim, M.D., Dae Won Kim, M.D., Yul Hee Cho, M.D., Sun Mie Yim, M.D., Ju Hyun Kang, M.D., Young Bin Joo, M.D., Hyeon Hui Kang, M.D., Jeong Sup Song, M.D., Ph.D., Hyoung Kyu Yoon, M.D., Ph.D.

Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

Address for correspondence: Hyoung Kyu Yoon, M.D., Ph.D. Division of Pulmonology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, 62, Yeouido-dong, Yeongdeungpo-gu, Seoul 150-713, Korea. Phone: 82-2-3779-2213, Fax: 82-2-780-3132, cmcyhg@catholic.ac.kr

Received 26 September 2011       Revised 30 September 2011       Accepted 22 November 2011

Copyright © 2012. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

While nontuberculous mycobacterium (NTM) infections are recently on the rise, arthritis caused by NTM is hardly reported in Korea. NTM arthritis has no distinctive clinical characteristics from chronic arthritis. Tuberculosis of the joint specifically produces similar clinical and pathologic presentations to NTM arthritis, so it is not easy to distinguish between them. We report a case of Mycobacterium intracellulare in an arthritis patient after trauma and surgical repair of the injury. At the beginning, the patient was diagnosed as tuberculous tenosynovitis through pathology without microbiologic evidence. The final diagnosis was made after subsequent recurrences for several years. The misdiagnosis and delayed diagnosis led to irreversible joint destruction and functional impairment. NTM infection must be included in the differential diagnosis of chronic arthritis at the outset.

Keywords: Arthritis, Mycobacterium avium-intracellulare Infection, Wounds and Injuries

Figures and Tables

Figure 1
Radiograph in anteroposterior (A) and medial oblique (B) projection of left wrist reveals arthrodesis state of radiocarpal and carpometacarpal joint with marked collapse and fusion in the carpal bones (hollow arrows). Distal ulna shows bony erosion and destruction (white arrows).
trd-72-191-g001
Figure 2
Histologic examination of excised soft tissue of left wrist shows chronic granulomatous inflammation with caseous necrosis (hollow arrows) and multinucleated giant cells (white arrow, H&E stain, ×100).
trd-72-191-g002

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