Chronic Tenosynovitis Caused by Mycobacterium terrae: A Case Report Highlighting a Diagnostic Challenge

We report a rare case of chronic tenosynovitis of the upper extremity caused by Mycobacterium terrae, an infrequent and underdiagnosed pathogen. A 64-year-old man presented with persistent pain and swelling in the hand following a minor puncture wound. Despite multiple empirical treatments, includin...

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Main Authors: Alex Giannini, Pietro Antonini
Format: Article
Language:English
Published: American College of Physicians 2025-08-01
Series:Annals of Internal Medicine: Clinical Cases
Online Access:https://www.acpjournals.org/doi/10.7326/aimcc.2024.1321
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author Alex Giannini
Pietro Antonini
author_facet Alex Giannini
Pietro Antonini
author_sort Alex Giannini
collection DOAJ
description We report a rare case of chronic tenosynovitis of the upper extremity caused by Mycobacterium terrae, an infrequent and underdiagnosed pathogen. A 64-year-old man presented with persistent pain and swelling in the hand following a minor puncture wound. Despite multiple empirical treatments, including corticosteroids, antibiotics, and antifungals, the condition progressed over several months (Figure 1). Surgical intervention, histopathologic examination revealing granulomatous inflammation, and prolonged microbiological culture ultimately identified M terrae. Susceptibility-guided antimicrobial therapy resulted in complete clinical resolution. This case highlights the diagnostic complexity of M terrae infections and emphasizes the importance of considering atypical pathogens in cases of chronic tenosynovitis, especially when conventional therapies fail.
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series Annals of Internal Medicine: Clinical Cases
spelling doaj-art-c010f46de5774d139a59cfc5e00fbbb82025-08-20T03:39:29ZengAmerican College of PhysiciansAnnals of Internal Medicine: Clinical Cases2767-76642025-08-014810.7326/aimcc.2024.1321Chronic Tenosynovitis Caused by Mycobacterium terrae: A Case Report Highlighting a Diagnostic ChallengeAlex Giannini0Pietro Antonini11Internal Medicine, Clinica Luganese Moncucco, Lugano, Switzerland2Internal Medicine and Tropical Diseases, Clinica Luganese Moncucco, Lugano, SwitzerlandWe report a rare case of chronic tenosynovitis of the upper extremity caused by Mycobacterium terrae, an infrequent and underdiagnosed pathogen. A 64-year-old man presented with persistent pain and swelling in the hand following a minor puncture wound. Despite multiple empirical treatments, including corticosteroids, antibiotics, and antifungals, the condition progressed over several months (Figure 1). Surgical intervention, histopathologic examination revealing granulomatous inflammation, and prolonged microbiological culture ultimately identified M terrae. Susceptibility-guided antimicrobial therapy resulted in complete clinical resolution. This case highlights the diagnostic complexity of M terrae infections and emphasizes the importance of considering atypical pathogens in cases of chronic tenosynovitis, especially when conventional therapies fail.https://www.acpjournals.org/doi/10.7326/aimcc.2024.1321
spellingShingle Alex Giannini
Pietro Antonini
Chronic Tenosynovitis Caused by Mycobacterium terrae: A Case Report Highlighting a Diagnostic Challenge
Annals of Internal Medicine: Clinical Cases
title Chronic Tenosynovitis Caused by Mycobacterium terrae: A Case Report Highlighting a Diagnostic Challenge
title_full Chronic Tenosynovitis Caused by Mycobacterium terrae: A Case Report Highlighting a Diagnostic Challenge
title_fullStr Chronic Tenosynovitis Caused by Mycobacterium terrae: A Case Report Highlighting a Diagnostic Challenge
title_full_unstemmed Chronic Tenosynovitis Caused by Mycobacterium terrae: A Case Report Highlighting a Diagnostic Challenge
title_short Chronic Tenosynovitis Caused by Mycobacterium terrae: A Case Report Highlighting a Diagnostic Challenge
title_sort chronic tenosynovitis caused by mycobacterium terrae a case report highlighting a diagnostic challenge
url https://www.acpjournals.org/doi/10.7326/aimcc.2024.1321
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