Nontuberculous mycobacterial osteomyelitis

Figures & data

Figure 1. (a) Acid-fast staining (AFB) test showing acid-fast bacilli in the monocytes (arrowheads). (b) CT scan of left humerus, with multiple vermiform destructions (arrowhead). (c) MRI of left humerus, T2-STIR, showing abnormal signal in the marrow (arrowhead).

Table I. English language articles on nontuberculous mycobacteria (NTM) osteomyelitis in patients with diabetes mellitus (DM).

Reference	Age/sex	Pathogen	Anatomic site	Underlying condition	Surgical treatment	Anti-NTM therapy	Outcome
Phoa et al. [70]	66/M	M. scrofulaceum	Wrist	DM	None	KAN, EMB, and ETH	Improved clinically
Satti et al. [84]	52/M	M. fortuitum	Bone marrow	DM	None	AMK and CIP	Cured
Argiris et al. [188]	37/M	MAC	Bone marrow	DM, ESRD, renal transplant	None	AZM and EMB	Died
Baylor et al. [189]	39/M	MAC	Humerus, tibia, and fibula	DM, schizophrenia	Surgical debridement	STR, CFZ, INH, EMB, RFP, PZA, CLR, and AMK	Cured
Iyengar et al. [95]	58/F	M. chelonae	Finger metacarpal heads	DM, ESRD	Incision for drain, surgical debridement	CFZ and CLR	Cured
Conejero et al. [190]	76/F	M. chelonae	Metatarsal and calcaneus	DM and RA	None	Intravenous IPM, CLR, and LVX	Cured
Halleran et al. [191]	61/M	MAC	Wrist	DM, hypertension	Aspiration	INH and RFP	Unresolved
Suzuki et al. [8]	67/M	MAC	Spine, ribs, and pelvis	DM	Surgical debridement	RFP, EMB, CLR, CS, and STR	Cured
This study	69/M	M. intracellulare	Humerus and ribs	DM	Anti-mycobacterial chemotherapy	CLR, EMB, and MXF	Died

AMK, amikacin; AZM, azithromycin; CFZ, clofazimine; CIP, ciprofloxacin; CLR, clarithromycin; CS, cycloserine; EMB, ethambutol; ESRD, end-stage renal disease; ETH, ethionamide; INH, isoniazide; IPM, imipenem; KAN, kanamycin; LVX, levofloxacin; MAC, M.avium-intracellulare complex; MXF, moxifloxacin; PZA, pyrazinamide; RA, rheumatoid arthritis; RFP, rifampicin; STR, streptomycin.

Phoa LL, Khong KS, Thamboo TP, Lam KN. A case of Mycobacterium scrofulaceum osteomyelitis of the right wrist. Ann Acad Med Singapore 2000;29:678–81.

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Satti L, Abbasi S, Sattar A, Ikram A, Manzar MA, Khalid MM. Bone marrow infection with Mycobacterium fortuitum in a diabetic patient. J Coll Physicians Surg Pak 2011;21:500–2.

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Argiris A, Maun N, Berliner N. Mycobacterium avium complex inclusions mimicking Gaucher's cells. N Engl J Med 1999;340:1372.

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Baylor P, Larson R. Mycobacterium avium septicemia with ARDS in a patient with diabetes mellitus and no other known immune-compromising condition. J Intensive Care Med 2009;24:140–3.

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Iyengar KP, Nadkarni JB, Gupta R, Beeching NJ, Ullah I, Loh WY. Mycobacterium chelonae hand infection following ferret bite. Infection 2013;41:237–41.

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Conejero R, Ara M, Lorda M, Rivera I. Mycobacterium chelonae infection in a patient being treated with adalimumab. Actas Dermosifiliogr 2012;103:69–71.

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Halleran WJ, Martin NL. Nontuberculous mycobacterial arthritis: report of a chronic case. J Kans Med Soc 1982;83:284–6.

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Suzuki T, Murai H, Miyakoshi N, Hongo M, Itoi E, Shimada Y. Osteomyelitis of the spine caused by mycobacterium avium complex in an immunocompetent patient. J Orthop Sci 2013;18:490–5.

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