Early diagnosis and multidisciplinary management of mycobacterial hand and wrist infections: a case series and review of the literature

Purpose: Mycobacterial infections of the hand are rare and often mimic other conditions, frequently leading to delayed diagnosis and treatment. We present three cases and propose a practical approach for early recognition and management.Methods: We retrospectively reviewed three patients (mean age, 72 years) who were treated between 2021 and 2024 for suspected mycobacterial tenosynovitis. All patients underwent en bloc surgical excision. Specimens were subjected to acid-fast bacilli staining, histopathological examination, Mycobacterium tuberculosis (MTB)/nontuberculous mycobacteria polymerase chain reaction, and mycobacterial cultures monitored at 4 and 8 weeks. Antimycobacterial chemotherapy, administered for 6–9 months, was initiated when clinical and histopathological findings suggested infection, following consultation with infectious disease specialists. The minimum follow- up was 12 months, with one patient followed for 24 months.Results: In all patients, diagnosis was delayed by at least 1 month. Histopathological examination consistently demonstrated chronic granulomatous inflammation. Cultures identified Mycobacterium intracellulare in one case and MTB in another, whereas one remained culture negative. One patient required early reoperation for a localized abscess, and another underwent delayed A2 pulley reconstruction. Antimycobacterial therapy was initiated at postoperative week 2 in two patients and at postoperative week 1 in one patient. Although no laboratory findings initially indicated mycobacterial infection, therapy was initiated when intraoperative findings or the clinical history strongly suggested a mycobacterial etiology. No treatment-related complications were observed, and all patients remained recurrence-free.Conclusion: Mycobacterial infections of the hand are diagnostically challenging. A multidisciplinary approach, along with recognition of clinical situations suspicious for mycobacterial infection, may facilitate timely and accurate diagnosis and help reduce recurrence and complications.