# Nontuberculous Mycobacterial Flexor Tenosynovitis of the Wrist and Hand

## TL;DR

This paper describes a rare case of hand and wrist infection caused by nontuberculous mycobacteria in an immunocompromised patient.

## Contribution

It highlights the importance of considering NTM in chronic hand swelling, especially in immunocompromised individuals.

## Key findings

- MRI showed flexor tenosynovitis and synovial hypertrophy in the left hand and wrist.
- Histology revealed noncaseating granulomas, and Mycobacterium intracellulare was identified in cultures.

## Abstract

Nontuberculous mycobacteria (NTM) are uncommon causes of cutaneous and musculoskeletal infections. Here, we present an immunocompromised patient with persistent swelling in the left hand, wrist, and distal forearm. MRI findings revealed flexor tenosynovitis with synovial hypertrophy of the left hand and wrist and loculated fluid containing rice bodies along the distal flexor digitorum muscles in the volar aspect of the left wrist. The patient underwent flexor tenosynovectomy, and histological examination of the excised tenosynovium and mass revealed noncaseating granulomas. Mycobacterium intracellulare was identified in microbiological cultures. Antimycobacterial therapy was administered postoperatively to manage the infection. This report underscores the significance of maintaining a high index of suspicion for NTM infection when assessing chronic hand swelling, particularly in individuals with compromised immune systems.