Kim JH, Koh IC, Lim SY, Kang SH, Kim H. Chronic intractable nontuberculous mycobacterial-infected wound after acupuncture therapy in the elbow joint: A case report. World J Clin Cases 2024; 12(36): 6926-6934 [DOI: 10.12998/wjcc.v12.i36.6926]
Corresponding Author of This Article
Hoon Kim, MD, PhD, Professor, Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Institute, No. 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, South Korea. prshoonkim@daum.net
Research Domain of This Article
Medical Informatics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 26, 2024; 12(36): 6926-6934 Published online Dec 26, 2024. doi: 10.12998/wjcc.v12.i36.6926
Chronic intractable nontuberculous mycobacterial-infected wound after acupuncture therapy in the elbow joint: A case report
Jong Hyup Kim, In Chang Koh, Soo Yeon Lim, Seong Hee Kang, Hoon Kim
Jong Hyup Kim, In Chang Koh, Soo Yeon Lim, Hoon Kim, Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Institute, Daejeon 35365, South Korea
Seong Hee Kang, Division of Infectious Diseases, Department of Internal Medicine, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Institute, Daejeon 35365, South Korea
Author contributions: Kim JH contributed to validation, formal analysis, investigation, resources, data curation, manuscript writing and editing, project administration, and funding acquisition; Koh IC contributed to conceptualization and validation; Lim SY contributed to visualization, manuscript writing and editing, and supervised the study; Kim H contributed to conceptualization, validation, manuscript writing and editing, and supervised the study; Kang SH contributed to conceptualization, formal analysis, investigation and resources; all authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hoon Kim, MD, PhD, Professor, Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Institute, No. 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, South Korea. prshoonkim@daum.net
Received: June 29, 2024 Revised: September 26, 2024 Accepted: October 15, 2024 Published online: December 26, 2024 Processing time: 123 Days and 20.2 Hours
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.
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.
