Mycobacterium fortuitum Infection Following Primary Achilles Tendon Debridement with Flexor Hallucis Longus Augmentation: A Case Report

Abstract

Mycobacterium fortuitum (M. fortuitum), a rapidly growing non-tuberculous mycobacterium is a well-recognized, yet uncommon cause of soft tissue infection. The incidence of post surgical wound infections from this organism is increasing. ² The presentation of infection is atypical and failure to consider this pathogen can cause diagnostic delay and increased morbidity. ¹² , ¹⁴ Achilles tendon debridement with FHL augmentation is commonly used in patients with chronic Achilles tendinosis. ⁴ Wound-edge necrosis is the most common surgical complication of this procedure, and superficial and deep infections are potentially devastating complications. ³

We report the case of a patient who underwent Achilles tendon debridement with flexor hallucis longus augmentation, whose postoperative course was complicated by a deep M. fortuitum infection. Critical to the identification and ultimate treatment of this particular pathogen is the utilization of appropriate intraoperative cultures and microbiologic testing. In addition, repeat aggressive irrigation and debridement procedures coupled with removal of foreign materials and the appropriate use of prolonged antibiotic therapy can result in a successful long-term outcome.