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

In a <i>Mycobacterium heraklionense</i> 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.