polyarticular. It is often essential to sample fluid from the joint space or bursa in order to identify any pathogen and tailor treatment. Another noteworthy aspect of our case is the pres- ence of articular pathology, including subchondral cysts, diffuse synovial thickening with pannus formation, and periarticular erosions. The pathology could be explained as a primary bone or joint infection that later spread to the bursa or repetitive mechanical friction between bone and skin leading to chronic bursitis. 12 A differential diagnosis of these changes could include common joint pathology, such as rheumatoid or psoriatic arthritis or, more rarely, HIV arthropathy; however, an indolent infectious process should also be included. The mechanism of infection in our patient remains unclear as he had no evidence of lung pathology, no other manifestations of disseminated M. kansasii , and no history of trauma to the area. Our patient’s case presentation and diagnosis stress the importance of further investigating unusual presenta- tions of uncommon infections in the immunocompromised patient population. CITATIONS 1. Bailey RK, Wyles S, Dingley M, Hesse F, Kent GW. The isolation of high catalase Mycobacterium kansasii from tap water. Clin Am Rev Respir Dis 1970;101:430-1. 2. Mazor Y, Sprecher H, Braun E. Mycobacteria kansasii disseminated disease. Israel Med Assoc J 2010;12:121-2. 3. Bernard L, Vincent V, Lortholary O, et al. Mycobacterium kansasii septic arthritis: French retrospective study of 5 years and review. Clin Infect Dis 1999 Dec;26(6):1455-60. 4. Witzig RS, Fazal BA, Mera RM, et al. Clinical manifestations and implications of coinfectionwith Mycobacterium kansasii and human immunodeficiency virus type 1. Clin Infect Dis 1995;21:77-85. 5. Ito M, Komatsu Y, Ushiki A, et al. An AIDS patient with immune reconstitution inflammatory syndrome due to pulmonary Mycobacterium kansasii infection during antiretroviral therapy. J Infect Chemother 2009 Oct;15(5):331-4. 6. Leader M, Revell P, Clarke G. Synovial infection with Mycobacterium kansasii . Ann Rheum Dis 1984;43:80–2. 7. Mathew SD, Tully CC, Borra H, et al. Septic subacromial bursitis caused by Mycobacterium kansasii in an immunocompromised host. Mil Med 2012 May;177(5):617-20. 8. Barham GS, Hargreaves DG. Mycobacterium kansasii olecranon bursitis. J Med Microbiol 2006;55:1745-6. 9. Woods G, Washington J. Mycobacteria other than Mycobacterium tuberculosis : Reviewof microbiologic and clinical aspects. Rev Infect Dis 1987;9:275-94. 10. Wolinsky E. Nontuberculous mycobacteria and associated diseases. Am Rev Respir Dis 1979;119:107-59. 11. Kenin A. Tuberculosis of the subdeltoid bursa. Bull Hosp Jt Dis 1950;11:128-33. 12. Norden C, Gillespie W, Nade S. Mycobacterial infections of the musculoskeletal system. In: Norden C, Gillespie W, Nade S (editors). Infections in bones and joints . Boston: Blackwell Scientific, 1994:211-30. 13. Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: Diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med
2007;175:367-416. 14. Spradling P, Drociuk D, McLaughlin S, et al. Drug-drug interactions in inmates treated for human immunodeficiency virus and Mycobacterium tuberculosis infection or disease: An institutional tuberculosis outbreak. Clin Infect Dis 2002 Nov 1;35(9):1106-12. 15. Puthanakit T, Oberdorfer P, Ukarapol N, et al. Immune reconstitution syndrome from nontuberculous mycobacterial infection after initiation of antiretroviral therapy in children with HIV infection. Pediatr Infect Dis 2006 Jul;25(7):645-8. Mr. Mickman is a Medical Student at the Louisiana State University School of Medicine in New Orleans. Dr. Caruthers is a Chief Resident in the Department of Medicine at the LSU Health Sciences Center in New Orleans. Dr. Spiegel is a Resident in the Department of Medicine at the LSUHSC-New Orleans. Mr. Schiro is a Medical Laboratory Technician in the Microbiology Department at the Interim LSU Hospital in New Orleans. Dr. Maffei is an Associate Professor of Clinical Medicine in the Department of Medicine, Section of Infectious Diseases/HIV, at the LSUHSC-NewOrleans and the Medical Director of the Infection Control Department at the Interim LSU Hospital in New Orleans. Dr. Sanders is the Chairman of the Department of Medicine, the Edgar Hull Professor of Medicine, and a Professor of Microbiology, Immunology, and Parasitology at the LSUHSC-NewOrleans. Dr. Lopez is the Vice Chair of Education in the Department of Medicine, the Richard Vial Professor of Medicine, and Assistant Dean of Student Affairs in the School of Medicine at the LSUHSC-New Orleans.
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