OSTEOMYELITIS AND TENOSYNOVITIS DUE TO MYCOBACTERIUM-MARINUM IN A FISH DEALER

Osteomyelitis caused by nontuberculous mycobacteria is rarely reported . We describe a case of tenosynovitis of the right middle finger and m etacarpal bone caused by Mycobacterium marinum in a fish dealer. This 52-year-old woman suffered progressive pain, numbness, tenderness, and erythematous swelling of the right middle finger over a 2-month perio d. A radiograph of the right hand disclosed osteolytic lesions at the third metacarpal bone and the third proximal phalanx. She was treated successfully with repeated surgical debridement and antimicrobial agen ts, including clarithromycin, ethambutol, rifampin, and doxycycline fo r 1 month, followed by ethambutol and clarithromycin. Pathologic exami nation of the debrided tissue disclosed epithelioid granuloma, caseous necrosis, and numerous acid-fast bacilli, which were later identified as M. marinum using conventional biochemical tests and by the charact eristic gas-liquid chromatogram of esterified cellular fatty acid. The wound healed completely after 7 months of treatment. The patient is s till under treatment, and clarithromycin and ethambutol will be given for a total of 18 months.