Chronic intractable nontuberculous mycobacterial-infected wound after acupuncture therapy in the elbow joint: A case report

Abstract

BACKGROUND

Musculoskeletal nontuberculous Mycobacterium (NTM) infections are rare, particularly post-acupuncture therapy, and present diagnostic challenges due to their infrequency and potential severity. Prompt recognition and appropriate management are crucial for optimal outcomes. NTM-infected wounds involving the joints are difficult to treat, and only a few cases have been reported.

CASE SUMMARY

We present a case of a chronic intractable NTM-infected wound on the elbow joint that completely healed with conservative wound care and antibiotic treatment. An 81-year-old woman presented with a chronic, ulcerative wound on the right elbow joint where she had undergone repeated acupuncture therapy for chronic intolerable pain. Magnetic resonance imaging revealed synovial thickening, effusion, and subcutaneous cystic lesions. An orthopedic surgeon performed open synovectomy and serial debridement. However, 1 month postoperatively, the wound had not healed and became chronic. A wound culture revealed NTM (Mycobacterium abscessus), and the patient was referred to the Department of Plastic and Reconstructive Surgery. Instead of surgical intervention, conservative wound care with intravenous antibiotics was provided, considering the wound status and the patient’s poor general condition. Complete wound healing was achieved in 12 months, with no impact on the range of motion of the elbow joint.

CONCLUSION

With clinical awareness, musculoskeletal NTM infection can be treated with conservative wound care and appropriate antimicrobial agents.

Keywords: Nontuberculous mycobacteria; Arthritis; Infectious; Acupuncture; Chronic wound; Case report

Core Tip: This report presents a rare case of a nontuberculous Mycobacterium (NTM)-infected wound involving the right elbow joint after repetitive acupuncture therapy due to chronic intolerable pain. Instead of surgical intervention, which is typically recommended for the treatment of musculoskeletal NTM infections, conservative therapy with wound care and antibiotics was chosen, considering the patient’s overall poor health and intolerance for surgical intervention and anesthesia. We present a clinically significant case where treatment was successful in a patient who was unable to tolerate surgical intervention.