mendocina which were susceptible to Cefepime and Piperacillin/Tazobactam. Antibiotics were deescalated to Cefepime monotherapy. Over the course of her hospitalization, the patient made a full recovery and returned to her neurological baseline. Discussion: Pseudomonas mendocina is mainly an environmental organism isolated from water and soil and rarely causes infection in humans. Despite its low incidence of pathogenicity, P. mendocina has
been known to cause severe infections. These severe infections include skin and soft tissue infections, infective endocarditis, peritonitis, meningitis and bacteremia. Though no definitive source of infection was identified in this case, her elephantiasis with bilateral heel ulcers may be a potential entry site for infection. With this case, we seek to contribute additional data about a rare pathogen that can cause severe infection in both immunocompetent and immunocompromised humans.
SLEIGHT OF HAND- A CASE OF MYCOBACTERIUM MARINUM TENOSYNOVITIS Caroline Stafford, Robert Thibodaux; Louisiana State University, Baton Rouge, LA.
Introduction: Mycobacterium marinum is a non- tuberculous mycobacterium which typically causes disease in saltwater and freshwater fish but can infrequently infect humans who have an occupation and/or hobby associated with water exposure. It typically causes skin and soft tissue infections on extremities in humans after skin abrasion and spreads along lymphatics. Delay in diagnosis and treatment is common and clinical history remains imperative to considering the diagnosis. Case: A 62-year-old woman with a history of giant cell arteritis (on Actemra), hypertension, type 2 diabetes, and osteoporosis presented with progressive left hand pain, swelling, and erythema. She initially presented 1 year prior with pain and swelling in her left hand which was diagnosed as non-infectious tenosynovitis treated with periodic steroid injections. She had noted intermittent left forearm nodules during this time. Two months prior to presentation she developed increased swelling, erythema, and pustular lesions on her left palm and fingers for which she underwent incision and drainage (I&D). Initial cultures revealed Staphylococcus epidermidis for which she received a 10-day course of antibiotics with mild improvement.
Subsequent acid fast bacillus (AFB) cultures became positive 2 weeks later for which she was initiated on rifampin, ethambutol, and azithromycin. Further history revealed that she had previously worked in a shrimp plant and was gardening prior to developing her left hand symptoms. An MRI of the left hand revealed significant tenosynovitis which required several I&Ds with washout. Routine cultures revealed methicillin-susceptible Staphylococcus aureus for which she received an appropriate 10-day course of antibiotics. Prior AFB culture ultimately revealed Mycobacterium marinum which will likely require at least 6 to 12 months of therapy. Discussion: Mycobacterium marinum typically presents as a solitary papulonodular lesion on an extremity, with potential for lymphatic spread similar to cutaneous Sporotrichosis. It can affect deeper structures such as tendons and bones especially in immunocompromised hosts which may require surgical intervention. This patient’s rheumatologic and immunocompromised status complicated her diagnosis. With its indolent nature, one must be vigilant in considering Mycobacterium marinum with thorough assessment of risk factors to avoid delay in diagnosis and treatment.
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