Figure 3.

Debridement and radical synovectomy of his flexor tendon sheath secondary to necrotizing soft tissue infection. Erythema and induration surrounded the open wound, as well as nonviable wound edges that failed to bleed with manipulation, raising concern for a necrotizing soft tissue infection. He was immediately taken for surgical debridement and radical synovectomy of the right ring finger flexor tendon sheath, and tissue from the tendon sheath was sent for routine and mycobacterial cultures. Intravenous clarithromycin and moxifloxacin were initiated to empirically cover any potential superinfection. Twenty-four hours after admission, he was discharged to complete a six-month course of oral moxifloxacin and clarithromycin. AFB cultures were retuned positive, consistent with persistent Mycobacterium marinum.