# Mycobacterium heraklionense hand tenosynovitis—a case description of a three-year treatment course and perioperative measurement of azithromycin target tissue concentrations

## TL;DR

A case study shows high local azithromycin concentrations in treating Mycobacterium heraklionense tenosynovitis, but bead removal was needed due to drainage.

## Contribution

Demonstrates that local azithromycin delivery achieves much higher target tissue concentrations than systemic administration.

## Key findings

- Azithromycin-loaded beads achieved over 100-fold higher local concentrations than systemic treatment.
- Beads caused excessive wound drainage requiring surgical removal.
- Local antibiotic administration may reduce bacterial burden but needs further study.

## Abstract

In a Mycobacterium heraklionense tenosynovitis case, we observed that azithromycin-loaded calcium sulfate beads placed in the surgical wound had minimal systemic absorption and achieved over 100-fold higher target tissue concentrations than a systemic azithromycin-based treatment regimen alone. However, continued excessive wound drainage necessitated surgical removal of the beads. While systemic antibiotics and surgery remain central to nontuberculous mycobacterial treatment, the role of local antibiotic administration in reducing the bacterial burden warrants further investigation.