Atypical Mycobacterial Osteoarticular Infection

Abstract

The incidence of atypical mycobacterium (AM) infection is 2.71 out of a population of 100.000. Most were pulmonary infection and extra pulmonary infection counted 3%. Arthritis and osteomyelitis caused by AM is rare. We successfuly treated two patients with arthritis and osteomyelitis coused by AM.
Case 1. A 62-year-old man with wrist pain and swelling for 6 years, was suspected as having RA. However, treatment for RA did not improve his symptom. He received synovectomy 3 times but synovitis recurred. Mycobacterium scrofulaceum was cultured from joint fluid. We started administration of RFP, INH, and SPFX with synovectomy. Eight months after surgery, no recurrence was seen and he returned to his original job.
Case 2. A 45-year-old man suffered from a wound by a metal wire penetrating his right foot while mowing the lawn. He was treated with antibiotics, but he developed osteomyelitis of the right talus. Osteomyelitis was treated by curettage 3 times but recurred. A culture of the pus revealed mycobacterium fortuitum. He was successfuly treated with CAM, IPM, and CPFX administration combined with curretage and AMK cement beads insertion. This cement beads were replaced by the cancellous bone, and AMK and DKB impregnated hydroxyapatite 5 weeks later. Eight months after surgery, there was no signs of infection and he returned to his original job as a policeman.