Sea Lion Bite-Induced Flexor Tenosynovitis with Novel <i>Neisseria zalophi</i> and Other Infection

Animal bites are associated with a high risk of infection, underscoring the importance of early intervention.Sea lion bites, in particular, are rare, and limited information is available regarding their clinical features and optimal management strategies 1) .We herein report a patient who developed purulent flexor tenosynovitis after a sea lion bite.We discuss the case details along with a review of the relevant literature to enhance the understanding of this uncommon injury and its management. Case reportA 24-year-old woman who was an aquarium keeper with no significant medical history presented to our hospital with an infected sea lion bite on the right forearm.The bite had occurred the previous day during feeding and been initially managed at an emergency center with wound closure and oral antimicrobials.However, the patient was referred to our facility due to worsening pain.A clinical examination revealed two bite wounds, each approximately 5 cm in length, on the right thumb and distal ulnar side of the forearm.The forearm was erythematous, edematous, warm, and tender, especially around bite sites.Her fingers were slightly flexed, and she experienced severe pain during finger extension (Fig. 1,left).There were no other systemic symptoms, such as a fever.Radiographs revealed no fractures, foreign bodies, or bone fusion.Magnetic resonance imaging (MRI) showed mild hyperintensity on T2 and STIR sequences along the superficial flexor side of the forearm, extending from the palmar thumb to the distal third of the forearm.In addition, marginal irregularities