Summary of - Unusual presentation of carpal tunnel syndrome due to Mycobacterium marinum infection of hand

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Article

Abstract

Background This case report details a rare instance of carpal tunnel syndrome in a fisherman caused by a Mycobacterium marinum infection of the hand. M. marinum is an atypical mycobacterium, often misdiagnosed due to overlapping symptoms with more common conditions like tuberculosis and rheumatoid arthritis. Case Presentation A fisherman in his 50s presented with severe pain, paresthesia, and restricted movement in his right hand, which escalated over two weeks. Clinical examination showed altered sensation and positive signs indicative of carpal tunnel syndrome. Initial imaging and laboratory tests were largely normal, except for an elevated erythrocyte sedimentation rate (ESR) of 30 mm/hour. A flexor tenosynovectomy revealed the presence of atypical mycobacteria. Diagnosis Despite the negative culture results for M. marinum, a smear of synovial tissue indicated the presence of acid-fast bacilli. Histological examination showed chronic synovitis with non-caseating granulomas. Given the diagnostic challenges, a combination of patient history and careful clinical investigation was crucial for identifying the infection. Treatment The patient underwent carpal tunnel release and synovectomy, followed by a six-month course of combination antimicrobial therapy, including clarithromycin, rifampicin, and doxycycline. Outcome At three months post-treatment, the patient experienced a significant reduction in pain and paresthesia. By six months, he regained full range of motion and returned to normal activities, showcasing the effectiveness of timely surgical intervention and appropriate antimicrobial therapy. Conclusion This case highlights the need for healthcare providers, particularly hand surgeons, to maintain a high index of suspicion for M. marinum infections. Early diagnosis, interdepartmental coordination, and combined treatment strategies are essential for optimal patient outcomes, especially in individuals with occupational exposure to aquatic environments.

Publication Date

2022

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