Acute Mycobacterial Flexor Tenosynovitis Following Accidental Bacillus Calmette-Guerin Inoculation in a Health Care Worker: Case Report

Solutions containing bacillus Calmette-Guerin (BCG), a live attenuated form of Mycobacterium bovis or Mycobacterium tuberculosis, commonly are injected intravesically to treat tumors of the urinary bladder. We report a case of acute mycobacterial flexor tenosynovitis in a health care worker who inadvertently inoculated her finger via needlestick while preparing BCG solution for intravesicular administration. She was treated successfully with immediate operative intervention followed by 6 months of antimycobacterial antibiotics. Of 3 previous reports of hand infections following self-inoculation with BCG solutions, this case is unique owing to rapid onset of acute mycobacterial flexor tenosynovitis and positive intraoperative mycobacterial cultures. Needlesticks with BCG-containing solutions, especially into the flexor tendon sheath, should be treated with timely surgical debridement and appropriate antimycobacterial management. (J Hand Surg 2013;38A:362-365. Copyright (C) 2013 by the American Society for Surgery of the Hand. All rights reserved.)