Mycobacterium fortuitum Infection Following Patellar Tendon Repair

Abstract

Mycobacterium fortuitum is a ubiquitous, rapidly growing mycobacterial species that is infrequently reported in the surgical literature. Clinically important infection with this organism has been described following trauma, injections, augmentation mammoplasty, and ultrasound hydrolipoclasia1-3. In the field of orthopaedic surgery, Mycobacterium fortuitum infection has been encountered only following prosthetic arthroplasty or fracture surgery with internal fixation4-9. We report the case of an otherwise healthy man who underwent patellar tendon repair that was complicated by Mycobacterium fortuitum infection. While an accurate diagnosis was delayed by several weeks, aggressive surgical and specific antimicrobial therapy resulted in a favorable outcome. We emphasize the importance of surgeon awareness of this pathogen in order to facilitate accurate diagnosis and appropriate treatment. The patient was informed that data concerning the case would be submitted for publication, and he consented. A forty-year-old man who worked as an attorney was referred to one of us from another institution two months after surgical repair of the left patellar tendon. Three weeks before the referral, the patient had surgical wound erythema and drainage, accompanied by fever and chills. Oral cephalexin was prescribed but resulted in no improvement. Culture specimens were not obtained at that time. The medical history was otherwise unremarkable. Examination revealed that the patient was 180 cm tall and weighed 95 kg. The systemic temperature, pulse rate, and blood pressure were normal. The patient had an anterior longitudinal left knee incision with diffuse, severe surrounding erythema. The wound was open and draining, with granulation tissue exposed both proximally and in the center. The range of knee motion was from 0° to 70°. The patellar height appeared to be symmetrical on both sides, and the patient could perform an active straight leg raise. Distal motor and sensory function was …