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Abstract
BackgroundThere are increasing reports on nosocomial Mycobacterium massiliense infection, but septic arthritis and osteomyelitis because of that microorganism is rare. This report focuses on the clinical aspects of M. massiliense arthritis outbreak concurrent with soft tissue infection.Case presentationAn outbreak of septic arthritis among patients who had been injected at a single clinic occurred in South Korea between April and September 2012. This may be associated with repeated injection of triamcinolone contaminated with M. massiliense. Nine of the Korean patients visited our hospital complaining of painful swelling of the knees. During treatment course, patients are suffered from soft tissue abscess around the injection site. Acid-fast bacilli culture for infected tissue was positive in five patients, and polymerase chain reaction for non-tuberculous mycobacteria was positive in four patients. They were treated with antibiotics, repeated arthroscopic surgeries, incision and drainage for a long time. All patients were eventually cured but three patients have suffered from a decreased range of motion.ConclusionEarly clinical suspicion and microbiological diagnosis are key factors in reducing morbidity since septic arthritis with M. massiliense manifests late after the injection and treatment of it is a laborious process.
Highlights
There are increasing reports on nosocomial Mycobacterium massiliense infection, but septic arthritis and osteomyelitis because of that microorganism is rare
Non-tuberculous mycobacteria (NTM) are ubiquitous in nature widely found in soil, wastewater, and other materials [1]
Mycobacterium abscessus complex is rapidly growing mycobacteria (RGM) characterized by growth in solid agar media within seven days and subclassified into three closely related subspecies of M. abscessus, M. massiliense, and M. bolletii [1]
Summary
The patients were treated with long term IV and oral antibiotics combined with repeated surgical interventions. M. massiliense is an emerging pathogen of soft tissue infection associated with procedure or surgery, septic arthritis and osteomyelitis rarely occur and its clinical information and therapeutic options are still not fully understood. We report this outbreak of septic arthritis by M. massiliense with characteristics of patients, clinical manifestations, laboratory and synovial fluid analysis, treatment duration and progress, highlight the difficulty in treating the M. massiliense infection and expect it to be a help in the diagnosis and treatment of septic arthritis caused by M. massiliense. Author details 1 Division of Infectious Disease, Department of Internal Medicine, Soon‐ chunhyang University Hospital, 59 Daesagwan‐ro, Yongsan‐gu, Seoul, Korea.
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