Mycobacterium kansasii arthritis of the elbow in an immunocompetent patient with a suspected soft-tissue tumor

Hideo Okuno, Hiroyuki Tanaka, Hideharu Hagiya, Hisao Yoshida, Shigeto Hamaguchi, Yumiko Hori, Eiichi Morii, Kenichiro Hamada, Hideki Yoshikawa, Kazunori Tomono

Research output: Contribution to journalArticle

Abstract

Mycobacterium kansasii is one of the major non-tuberculous mycobacteria species that typically cause pulmonary diseases. M. kansasii is known to cause septic arthritis as an extrapulmonary disease in immunosuppressed patients or chronic skin disease. Herein, we present a case of M. kansasii arthritis involving the elbow of an immunocompetent patient, which was initially suspected to be a soft-tissue tumor. A 70-year-old man presented with a swollen left elbow that had progressed for 18 months with deteriorating arthralgia and limited range of motion. Magnetic resonance imaging revealed filling of the intra-articular space of the elbow and surrounding of the radial head with a soft tissue mass with mixed signal intensity. Initial incisional biopsy was performed via the lateral approach to the elbow joint, and pathological examination of the mass did not reveal any evidence of malignancy. One year after the first operation, arthroscopic surgery was performed to excise the mass following the recurrence of swelling and limited function of the elbow. Pathological examination of the resected synovium revealed epithelioid granulomas containing a multinucleated giant cell and inflammatory cell infiltration, characteristic of mycobacterial infection. M. kansasii was cultured after 2 weeks of incubation of the synovial sample. He experienced full resolution of the swelling and limited function following a combination of synovectomy and multidrug antimycobacterial treatment (rifampin 600 mg/day, clarithromycin 800 mg/day, and ethambutol 750 mg/day). This case highlights the need to consider this rare infection in the differential diagnosis of intra-articular soft tissue tumor-like lesions even in immunocompetent patients.

Original languageEnglish
Pages (from-to)261-264
Number of pages4
JournalJournal of Infection and Chemotherapy
Volume26
Issue number2
DOIs
Publication statusPublished - Feb 2020

Keywords

  • Extrapulmonary disease
  • Immunocompetent
  • Mycobacterium kansasii
  • Non-tuberculous mycobacteria

ASJC Scopus subject areas

  • Microbiology (medical)
  • Pharmacology (medical)
  • Infectious Diseases

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  • Cite this

    Okuno, H., Tanaka, H., Hagiya, H., Yoshida, H., Hamaguchi, S., Hori, Y., Morii, E., Hamada, K., Yoshikawa, H., & Tomono, K. (2020). Mycobacterium kansasii arthritis of the elbow in an immunocompetent patient with a suspected soft-tissue tumor. Journal of Infection and Chemotherapy, 26(2), 261-264. https://doi.org/10.1016/j.jiac.2019.07.015