|
1
|
Chen L, Chen J, Kong Y, Xiong X, Ying T, Hu B, Zheng Y. Ultrasonographic findings and differential diagnosis of acute calcific periarthritis in hands. Clin Rheumatol 2025; 44:1899-1905. [PMID: 40128443 DOI: 10.1007/s10067-025-07371-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 01/22/2025] [Accepted: 02/13/2025] [Indexed: 03/26/2025]
Abstract
OBJECTIVES To explore the feasibility of using high-frequency ultrasound for the diagnosis and differential diagnosis of acute calcific periarthritis (ACP). METHOD A total of 35 ACP patients in Group A and 38 gouty patients in Group B underwent ultrasound examination. All the ultrasound images were observed and analysed, and the sizes of the tophi and calcifications in the hands were measured. The differences in ultrasound features between Group A and Group B were examined. A t test was used to determine significant differences in size between ACP calcifications and gouty tophi. RESULTS The mean size of the tophus (9.54 ± 5.51 mm) was significantly larger than that of the ACP calcification (4.3 ± 1.51 mm). The double contour sign, bone erosion and synovitis were present in Group B (gout) but not in Group A (ACP). The calcification in all patients in Group A was almost completely resolved at the 1-month follow-up, as confirmed by ultrasound examination. CONCLUSIONS High-frequency ultrasound appears to be a useful diagnostic tool for identifying ACP and can reduce the use of unnecessary diagnostic tests, invasive procedures, inappropriate medications and surgery. Key Points • High-frequency ultrasound effectively differentiates between acute calcific periarthritis (ACP) and gout by identifying distinct ultrasound features. • This study revealed that the size of the tophus in gout patients was significantly larger than the calcification size in ACP patients. • Unique ultrasound signs, such as the double contour sign and bone erosion, were present in gout patients but absent in ACP patients, aiding in accurate diagnosis. • Follow-up ultrasound examinations revealed significant resolution of calcifications in ACP patients, reinforcing the utility of the tool in monitoring disease progression.
Collapse
Affiliation(s)
- Li Chen
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, 600 Yishan Road, 201306, Shanghai, People's Republic of China
| | - Jie Chen
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, 600 Yishan Road, 201306, Shanghai, People's Republic of China
| | - Yudong Kong
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, 600 Yishan Road, 201306, Shanghai, People's Republic of China
| | - Xiaoxian Xiong
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, 600 Yishan Road, 201306, Shanghai, People's Republic of China
| | - Tao Ying
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, 600 Yishan Road, 201306, Shanghai, People's Republic of China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, 600 Yishan Road, 201306, Shanghai, People's Republic of China
| | - Yuanyi Zheng
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, 600 Yishan Road, 201306, Shanghai, People's Republic of China.
| |
Collapse
|
|
2
|
Ramirez DC, Ren R, Burge AJ, Potter HG, Su E, Bauer TW. Exuberant Rice Body Formation Associated with Adverse Local Tissue Reaction After Hip Resurfacing Arthroplasty: A Case Report and Review of the Literature. JBJS Case Connect 2023; 13:01709767-202306000-00006. [PMID: 37053362 DOI: 10.2106/jbjs.cc.22.00524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
CASE A 65-year-old man with osteoarthritis of the hip developed a soft-tissue mass of the inferior gluteal region 3 years after metal-on-metal resurfacing hip arthroplasty. Clinical and imaging findings suggested an adverse local tissue reaction. Intraoperatively, nearly 1 liter of intra-articular fibrinous loose bodies (rice bodies) was removed, and histology showed features of an adaptive immune response. The patient had no evidence of an autoimmune disease or mycobacterial infection. CONCLUSION To our knowledge, this is the first reported case of florid rice bodies associated with a metal-on-metal hip arthroplasty and adverse local tissue reaction.
Collapse
Affiliation(s)
- Daniel C Ramirez
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
| | - Renee Ren
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement (ARJR), Hospital for Special Surgery, New York, New York
| | - Alissa J Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Edwin Su
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement (ARJR), Hospital for Special Surgery, New York, New York
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
| |
Collapse
|
|
3
|
Tian Y, Zhou HB, Yi K, Wang KJ. Idiopathic tenosynovitis of the wrist with multiple rice bodies: A case report and review of literature. World J Clin Cases 2022; 10:11908-11920. [PMID: 36405290 PMCID: PMC9669876 DOI: 10.12998/wjcc.v10.i32.11908] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/19/2022] [Accepted: 10/19/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Multiple rice bodies in the wrist is a rare disorder that requires surgery, and there are still many uncertainties regarding its diagnosis and treatment.
CASE SUMMARY We described a rare case of chronic idiopathic tenosynovitis with rice bodies of the wrist in a 71-year-old man and reviewed similar topics in the literature. A total of 43 articles and 61 cases were included in the literature review. Our case had a usual presentation: it was similar to those in the literature. The affected population was mainly older adults, with an average age of 59.43 (range, 3 to 90) years. The male-to-female ratio was 1.54:1 (37/24).Most of them showed limited swelling and pain, only 23.0% had carpal tunnel symptoms, and the average disease duration was 18.03 (0.5-60) mo. Wrist flexor tendon sheath involvement was the most common (95.1%, 58/61), and only 3 cases had extensor tendon sheath involvement.The main causes were tuberculosis (34.4%, 21/61), non-tuberculous mycobacteria (24.6%, 15/61), idiopathic tenosynovitis (31.1%, 19/61), and others (9.84%, 6/61). There were 10 patients with recurrences; in 6 of them, were due to non-tuberculous mycobacterial infections.
CONCLUSION We reported a case of wrist idiopathic tenosynovitis with rice body formation, and established a clinical management algorithm for wrist tenosynovitis with rice bodies, which can provide some reference for our clinical diagnosis and treatment. The symptoms of rice-body bursitis of the wrist are insidious, nonspecific, and difficult to identify. The aetiology is mainly idiopathic tenosynovitis and mycobacterial (tuberculosis or non-tuberculous) infections; the latter are difficult to treat and require long-duration systemic combination antibiotic therapies. Therefore, before a diagnosis of idiopathic tenosynovitis is made, we must exclude other causes, especially mycobacterial infections.
Collapse
Affiliation(s)
- Yong Tian
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Hong-Bin Zhou
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Kai Yi
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Kai-Jian Wang
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| |
Collapse
|
|
4
|
Jeon CH, Kim TW, Park JY, Hwang CS, Lim S. Mycobacterium intracellulare Tenosynovitis with Rice Body Formation with Literature Review. Infect Chemother 2022:54.e61. [DOI: 10.3947/ic.2022.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/11/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Cheon Hoo Jeon
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Joon Young Park
- Department of Pathology, School of Medicine, Pusan National University, Yangsan, Korea
| | - Chung Su Hwang
- Department of Pathology, School of Medicine, Pusan National University, Yangsan, Korea
| | - Seungjin Lim
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
|
5
|
Bianchi S, Hoffman DF, Tamborrini G, Poletti PA. Ultrasound Findings in Less Frequent Causes of Carpal Tunnel Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2469-2482. [PMID: 32459879 DOI: 10.1002/jum.15349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/03/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
The most common etiology of carpal tunnel syndrome (CTS) is idiopathic. However, secondary causes of CTS should be considered when symptoms are unilateral, or electrodiagnostic studies are discrepant with the clinical presentation. Imaging of the carpal tunnel should be performed when secondary causes of CTS are suspected. An ultrasound evaluation of the carpal tunnel can assess for pathologic changes of the median nerve, detect secondary causes of CTS, and aid in surgical planning.
Collapse
Affiliation(s)
- Stefano Bianchi
- Cabinet d'Imagerie Médicale SA, Geneva, Switzerland
- Division of Radiology, Hopitaux Universitaires de Genève, Geneva, Switzerland
| | - Douglas F Hoffman
- Departments of Orthopedics and Radiology, Essentia Health, Duluth, Minnesota, USA
| | - Giorgio Tamborrini
- Ultraschall Zentrum Rheumatologie Aeschenvorstadt, Basel, Switzerland
- Rheumatology University Hospital Basel, Basel, Switzerland
| | | |
Collapse
|
|
6
|
Tabrizi A, Mohammadi S, Ghasemi-Rad M, Dindarian S. Unusual presentation of rice body formation in a patient without tuberculosis or rheumatic disease: report of a rare case and literature review. CURRENT ORTHOPAEDIC PRACTICE 2020; 31:305-310. [DOI: 10.1097/bco.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ali Tabrizi
- Assistant professor, Department of Orthopedics, Urmia University of Medical Sciences, Urmia, Iran
| | - Sedra Mohammadi
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Sina Dindarian
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
|
7
|
Kim DH, Min S, Lee HJ, Kim HJ, Lee H, Yoon JP. Synchronization of Synovial Chondromatosis and Mycobacterium intracellurae Infection in Olecranon Bursitis: A Case Report. Clin Shoulder Elb 2019; 22:46-49. [PMID: 33330194 PMCID: PMC7713878 DOI: 10.5397/cise.2019.22.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/26/2022] Open
Abstract
A 73-year-old woman presented with a recurrent cystic mass around her left olecranon. She had a history of 8 steroid injections due to elbow pain beginning 3 years ago and twice had undergone aspiration of olecranon bursitis that developed two months prior to presentation. She had been taking medications for hypertension and diabetes with no pertinent past history. On magnetic resonance imaging (MRI), there were multiple nodules in the olecranon bursa, which were isointense to muscle on T1-weighted images and hyperintense to muscle on T2-weighted images. Our initial diagnosis was synovial chondromatosis. On bursoscopy, masses of gray-white colored nodules were observed in the bursa. Finally, synovial chondromatosis and non-tuberculous mycobacterial infection were concurrently diagnosed. In conclusion, uncalcified synovial chondromatosis and rice bodies can have similar visual and MRI characteristics; therefore, we suggest that clinicians should be aware of the possibility of other infections in cases of this type.
Collapse
Affiliation(s)
- Dong Hyun Kim
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seunggi Min
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyun Joo Lee
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hee-June Kim
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hoseok Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| |
Collapse
|
|
8
|
Abstract
Although less common as causes of musculoskeletal infection than pyogenic bacteria, both Mycobacterium tuberculosis and nontuberculous mycobacteria can infect bones and joints. Although tuberculous arthritis and osteomyelitis have been recognized for millennia, infections caused by nontuberculous mycobacteria are being identified more often, likely because of a more susceptible host population and improvements in diagnostic capabilities. Despite advances in modern medicine, mycobacterial infections of the musculoskeletal system remain particularly challenging to diagnose and manage. This article discusses clinical manifestations of musculoskeletal infections caused by Mycobacterium tuberculosis and nontuberculous mycobacteria. Pathogenesis, unique risk factors, and diagnostic and therapeutic approaches are reviewed.
Collapse
Affiliation(s)
- John I Hogan
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA
| | - Rocío M Hurtado
- Mycobacterial Diseases Center, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA
| | - Sandra B Nelson
- Program in Musculoskeletal Infections, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA.
| |
Collapse
|
|
9
|
Abstract
Nontuberculous mycobacteria (NTM) diseases mainly manifest as pulmonary illnesses, but 20 -30% of NTM isolates originate from extrapulmonary diseases. These diseases cause a variety of clinical syndromes, including skin and soft-tissue infections, musculoskeletal infections, lymphadenitis, and disseminated disease. In skin and soft-tissue infections, musculoskeletal infections, prolonged treatment with combinations of antibiotics is effective in the treatment of NTM diseases, with surgery as an important complementary tool. The recommended duration of therapy for skin and soft-tissue infection is usually 2 – 4 months for mild disease and 6 months for severe disease, while treatment of musculoskeletal NTM disease usually requires at least 6 - 12 months. Management options of NTM lymphadenitis include surgical intervention, medical therapy, or observation. Treatment of disseminated NTM disease generally requires 6 to 12 months after immune restoration. However, despite a considerable increase in knowledge about NTM diseases, determining optimal treatment approaches remains a complex and challenging task.
Collapse
Affiliation(s)
- Yu Mi Wi
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University, Changwon, Korea.
| |
Collapse
|
|
10
|
Abstract
Although less common as causes of musculoskeletal infection than pyogenic bacteria, both Mycobacterium tuberculosis and nontuberculous mycobacteria can infect bones and joints. Although tuberculous arthritis and osteomyelitis have been recognized for millennia, infections caused by nontuberculous mycobacteria are being identified more often, likely because of a more susceptible host population and improvements in diagnostic capabilities. Despite advances in modern medicine, mycobacterial infections of the musculoskeletal system remain particularly challenging to diagnose and manage. This article discusses clinical manifestations of musculoskeletal infections caused by Mycobacterium tuberculosis and nontuberculous mycobacteria. Pathogenesis, unique risk factors, and diagnostic and therapeutic approaches are reviewed.
Collapse
Affiliation(s)
- John I Hogan
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA
| | - Rocío M Hurtado
- Mycobacterial Diseases Center, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA
| | - Sandra B Nelson
- Program in Musculoskeletal Infections, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA.
| |
Collapse
|
|
11
|
Moreno S, Forcada P, Soria X, Altemir V, Gatius S, Gil M, Matías-Guiu X, Casanova JM, Martí RM. Tenosynovitis with rice body formation presenting as a cutaneous abscess. J Cutan Pathol 2014; 41:602-5. [PMID: 24673442 DOI: 10.1111/cup.12316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/19/2013] [Accepted: 02/09/2014] [Indexed: 11/29/2022]
Abstract
A 62-year-old woman with a past medical history of rheumatoid arthritis was referred to the Department of Dermatology because of an enlarging cutaneous lesion on the right thumb which resembled a soft tissue infection. She had received antibiotics without significant improvement. Clinical examination revealed an erythematous nodule involving almost the whole surface of the distal phalanx with spontaneous drainage of countless of small yellowish ovoid granules. Histopathologic study of these structures showed an inner core of amorphous acidophilic material with some interspersed chronic inflammatory cells and a surrounding thin fibrin layer. Special stains and cultures were negative for parasites, bacterium and mycobacterium. Magnetic resonance imaging (MRI) revealed distension of the first and fifth finger flexor sheaths and common finger flexor sheath. These areas were filled by fluid and multiple small nodular lesions. A diagnosis of non-infectious rice body tenosynovitis was rendered and surgical removal was performed. Total recovery was observed with no evidence of recurrence after 6 months of follow-up. To our knowledge, this is the first report of rice body tenosynovitis presenting as a pseudoinflammatory cutaneous lesion with evolution to a cutaneous fistula with drainage of rice grain-like structures. The description of this impressive and peculiar clinical and histopathologic picture is important to further recognize similar cases.
Collapse
Affiliation(s)
- Sara Moreno
- Department of Dermatology, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRB Lleida, Lleida, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
|
12
|
Abstract
Atypical tuberculous tenosynovitis of the foot and ankle is extremely rare. The determination of the Mycobacterium species is essential because resistance of atypical mycobacterial strains to antituberculous drugs is often encountered. We report a case of Mycobacterium chelonae paratendinous and intratendinous infection involving the Achilles tendon. Repeat aggressive irrigation and debridement procedures, coupled with removal of foreign materials and the appropriate use of prolonged antibiotic therapy, can result in a successful long-term outcome.
Collapse
Affiliation(s)
- Tun Hing Lui
- Consultant, Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China.
| | - Kwok Bill Chan
- Associate Consultant, Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China
| |
Collapse
|
|
13
|
Jeong YM, Cho HY, Lee SW, Hwang YM, Kim YK. Candida septic arthritis with rice body formation: a case report and review of literature. Korean J Radiol 2013; 14:465-9. [PMID: 23690715 PMCID: PMC3655302 DOI: 10.3348/kjr.2013.14.3.465] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 02/06/2013] [Indexed: 11/15/2022] Open
Abstract
Rice body formation in a joint or bursa is a rare condition, and is usually associated with rheumatoid arthritis or tuberculous arthritis. Here we describe a case of multiple rice body formation in a shoulder joint and in adjacent bursae, which was confirmed to be due to septic arthritis by Candida species. To the best of our knowledge, rice body formation in Candida septic arthritis in an immune-competent patient has not been previously reported.
Collapse
Affiliation(s)
- Yu Mi Jeong
- Department of Radiology, Gachon University, Gil Hospital, Incheon 405-760, Korea.
| | | | | | | | | |
Collapse
|
|
14
|
Genetic diversity and population structure of Mycobacterium marinum: new insights into host and environmental specificities. J Clin Microbiol 2012; 50:3627-34. [PMID: 22952269 DOI: 10.1128/jcm.01274-12] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Mycobacterium marinum causes a systemic tuberculosis-like disease in fish and skin infections in humans that can spread to deeper structures, resulting in tenosynovitis, arthritis, and osteomyelitis. However, little information is available concerning (i) the intraspecific genetic diversity of M. marinum isolated from humans and animals; (ii) M. marinum genotype circulation in the different ecosystems, and (iii) the link between M. marinum genetic diversity and hosts (humans and fish). Here, we conducted a genetic study on 89 M. marinum isolates from humans (n = 68) and fish (n = 21) by using mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) typing. The results show that the M. marinum population is genetically structured not only according to the host but also according to the ecosystem as well as to tissue tropism in humans. This suggests the existence of different genetic pools in the function of the biological and ecological compartments. Moreover, the presence of only certain M. marinum genotypes in humans suggests a different zoonotic potential of the M. marinum genotypes. Considering that the infection is linked to aquarium activity, a significant genetic difference was also detected when the human tissue tropism of M. marinum was taken into consideration, with a higher genetic polymorphism in strains isolated from patients with cutaneous forms than from individuals with deeper-structure infection. It appears that only few genotypes can produce deeper infections in humans, suggesting that the immune system might play a filtering role.
Collapse
|
|
15
|
Moores CD, Grewal R. Radical surgical debridement alone for treatment of carpal tunnel syndrome caused by mycobacterium avium complex flexor tenosynovitis: case report. J Hand Surg Am 2011; 36:1047-51. [PMID: 21571445 DOI: 10.1016/j.jhsa.2011.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 03/08/2011] [Accepted: 03/08/2011] [Indexed: 02/02/2023]
Abstract
We present a case of proliferative flexor tenosynovitis caused by Mycobacterium avium complex resulting in recurrent symptoms of median nerve compression. The patient was treated with radical tenosynovectomy and release of the carpal tunnel without antimicrobial therapy. She remains symptom-free and is apparently disease-free more than 2 years after surgery.
Collapse
Affiliation(s)
- Carl D Moores
- Department of Orthopedic Surgery, Memorial University of Newfoundland, Newfoundland
| | | |
Collapse
|
|
16
|
Rice Bodies, Millet Seeds, and Melon Seeds in Tuberculous Tenosynovitis of the Hand and Wrist. Ann Plast Surg 2011; 66:610-7. [DOI: 10.1097/sap.0b013e3181e35ca5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
|
17
|
Turecki MB, Taljanovic MS, Stubbs AY, Graham AR, Holden DA, Hunter TB, Rogers LF. Imaging of musculoskeletal soft tissue infections. Skeletal Radiol 2010; 39:957-71. [PMID: 19714328 DOI: 10.1007/s00256-009-0780-0] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 08/03/2009] [Accepted: 08/06/2009] [Indexed: 02/02/2023]
Abstract
Prompt and appropriate imaging work-up of the various musculoskeletal soft tissue infections aids early diagnosis and treatment and decreases the risk of complications resulting from misdiagnosis or delayed diagnosis. The signs and symptoms of musculoskeletal soft tissue infections can be nonspecific, making it clinically difficult to distinguish between disease processes and the extent of disease. Magnetic resonance imaging (MRI) is the imaging modality of choice in the evaluation of soft tissue infections. Computed tomography (CT), ultrasound, radiography and nuclear medicine studies are considered ancillary. This manuscript illustrates representative images of superficial and deep soft tissue infections such as infectious cellulitis, superficial and deep fasciitis, including the necrotizing fasciitis, pyomyositis/soft tissue abscess, septic bursitis and tenosynovitis on different imaging modalities, with emphasis on MRI. Typical histopathologic findings of soft tissue infections are also presented. The imaging approach described in the manuscript is based on relevant literature and authors' personal experience and everyday practice.
Collapse
Affiliation(s)
- Marcin B Turecki
- Department of Radiology, University of Arizona, Tucson, AZ 85724, USA.
| | | | | | | | | | | | | |
Collapse
|
|
18
|
Chronic Granulomatous Tenosynovitis Due to Mycobacterium marinum. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2010. [DOI: 10.1097/ipc.0b013e3181bf60e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
|
19
|
Abstract
Joint pains and swellings are routine complaints in rheumatology clinics. Infectious diseases may mimic common rheumatic conditions and thus need to be ruled out before initiating any immunosuppressive treatment. Mycobacterium marinum is an organism that can present with a typical arthritis picture. A 60-year-old gentleman with a complicated medical history presented with a right wrist swelling which was initially managed as a case of remitting seronegative arthritis. He eventually required tenolysis and the biopsy showed M. marinum. On inquiry, he was found to be an avid fisherman. This report discusses typical diagnostic pitfalls, literature review on the reported cases and treatment strategies. The most important point is to ask for occupational and hobby history in such cases.
Collapse
|
|
20
|
Doumas C, Vazirani RM, Clifford PD, Owens P. Acute calcific periarthritis of the hand and wrist: a series and review of the literature. Emerg Radiol 2007; 14:199-203. [PMID: 17541659 DOI: 10.1007/s10140-007-0626-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 05/03/2007] [Indexed: 10/23/2022]
Abstract
This article presents three patients with acute calcific periarthritis (ACP) of the hand and wrist. ACP is an unusual, painful, monoarticular, periarticular inflammatory process associated with juxtaarticular deposits of amorphous calcium hydroxyapatite. ACP is a distinct clinical subset of hydroxyapatite deposition disease. ACP has a high rate of misdiagnosis because of its rare occurrence and its clinical resemblance to other entities. Clinical presentation may simulate infection, and the associated periarticular calcifications may be mistaken for gout, pseudogout, or other entities. One third of patients with ACP provide a history of antecedent trauma. Treatment is conservative. Patients typically will have a reduction in symptoms within 4-7 days after the acute onset of pain. Radiographically, the periarticular mineralization usually resolves or markedly decreases within 2-3 weeks, although on occasion, some calcifications may remain visible for months. Failure to recognize and correlate the typical clinical and radiographic presentation of this disease may lead to unnecessary diagnostic tests, invasive procedures, and inappropriate medication.
Collapse
Affiliation(s)
- Christopher Doumas
- Department of Orthopedics, University of Pennsylvania Hospitals, Philadelphia, PA, USA.
| | | | | | | |
Collapse
|
|
21
|
Tyllianakis M, Kasimatis G, Athanaselis S, Melachrinou M. Rice-body formation and tenosynovitis of the wrist: a case report. J Orthop Surg (Hong Kong) 2006; 14:208-211. [PMID: 16914791 DOI: 10.1177/230949900601400221] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A 61-year-old woman presented with mild pain and swelling on the volar aspect of the wrist, hand, and little finger. Radiography showed a soft-tissue mass shadow, and magnetic resonance imaging showed acute tenosynovitis of the flexor tendons and an inflammatory mass inside the carpal tunnel. Laboratory test results were normal, except for an elevated erythrocyte sedimentation rate (40 mm/h). The patient had an ambiguous Mantoux test result but no history of mycobacterial exposure. Exhaustive investigations for rheumatic disease were negative. Surgical exploration of the lesion revealed rice bodies in the common flexor tendon synovial sheath, extending distally to the tip of the fifth finger. Removal of the rice bodies and thorough excision of the sheath was performed. The patient regained a full and painless range of motion in about 3 months. One-year follow-up revealed no underlying disorder.
Collapse
Affiliation(s)
- M Tyllianakis
- Department of Orthopaedic Surgery, University Hospital of Patras, Greece.
| | | | | | | |
Collapse
|
|
22
|
Huang GS, Lee CH, Chen CY. Clinical images: Tuberculous rice bodies of the wrist. ACTA ACUST UNITED AC 2005; 52:1950. [PMID: 15934133 DOI: 10.1002/art.21057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | | | | |
Collapse
|