A Refractory Granuloma of Mycobacterial Infection in a Digit-A Case Report

Abstract

Background: Mycobacterial infection is rarely common. The treatment is often delayed due to lack of clinical suspicion which would lead to the special diagnostic procedures. Aim and Objectives: We would like to highlight the unusual infection and difficulty of diagnosis as well as the treatment modalities. Materials and Methods: We report a 19-year-old healthy male with a precedent history of a penetrating injury to the right little finger. The next day he developed finger swelling, followed by a granuloma. Recurrence on the dorsal aspect of the proximal interphalangeal (PIP) joint of right little finger was encountered after local excision by a dermatologist. Results: The granuloma, involving the extensor tendon, was widely excised and the tendon was directly repaired. The histopathology revealed chronic granulomatous inflammation with caseous necrosis and Langhans cells. The Ziehl-Neelsen stain was positive. The polymerase chain reaction for the detection of Mycobacterium tuberculosis (TB-PCR) test showed positive Mycobacterium tuberculosis complex infection. The anti-mycobacterial agents were started postoperatively. There is no recurrence in 10-week follow-up and the range of motion of right little finger is satisfactory. The patient remains followed in the outpatient department. Conclusion: We should keep in mind that a refractory ulcer or granuloma may be caused by mycobacterial infection. The treatment is usually surgical debridement followed by anti-mycobacterial therapies for a period of 6 months.