Abstract
Introduction: Mycobacterium heraklionense is a newly described species member of the Mycobacterium terrae complex. Case presentation: We have described a case of chronic tenosynovitis caused by M. heraklionense using 16S rRNA gene sequencing. The infection was associated with trauma and foreign‐body introduction in an otherwise healthy patient. Conclusion: M. heraklionense appears to have worldwide distribution and has the ability to cause disease similar to other members of the M. terrae complex.
Highlights
Mycobacterium heraklionense is a newly described species member of the Mycobacterium terrae complex.Case presentation: We have described a case of chronic tenosynovitis caused by M. heraklionense using 16S rRNA gene sequencing
We describe the first report, to our knowledge, of infection caused by M. heraklionense: a chronic tenosynovitis associated with trauma and foreignbody introduction in an otherwise healthy individual
Mycobacterium terrae complex (MTC) are Runyon group III and nonpigmented, with an intermediate growth rate (5–15 days are required for the development of clearly visible colonies from dilutions inoculated on solid medium)
Summary
Mycobacterium heraklionense is a newly proposed species closely related to Mycobacterium arupense and is a member of the Mycobacterium terrae complex (MTC) (Tortoli et al, 2013). A second exploratory procedure 2 months later demonstrated proliferative tenosynovitis in the left palm and third digit, but again no foreign body was encountered Tissue from his left middle finger was submitted for bacterial, fungal and acid-fast bacillus (AFB) cultures. After about 3 months on this regimen, he developed severe neutropenia and all medications were stopped He was untreated for 2 months during which time he had a complete recovery of the blood counts, but on follow-up, his hand was found to be more swollen, not red, tender or warm. As a result of 16S rRNA gene sequencing, the organism was identified as M. heraklionense Based on this information, a course of therapy was initiated with rifabutin, ethambutol and azithromycin. Using a combination of rifampin and ethambutol, the effect was additive and yielded a rifampin MIC of 0.25 mg ml and an ethambutol MIC of 1.25 mg ml
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