Unresolved swelling of the hand: Think of Mycobacterium marinum infection

The surgical intervention and adjuvant locally applied measures to reduce the impact of a severe cutaneous hand infection caused by Mycobacterium marinum in a 48-year-old diver, receiving anti-TNFa (anti-tumor necrosis factor αlpha) treatment are presented herein. Careful surgical intervention- considered controversial so far-and lateral thinking are essential for the outcome of musculoskeletal infections caused by M marinum. Locally applied disinfection strategies inspired from fields other than medical (e.g. environmental biology) and clearly set surgery goals - aiming at optimizing tissue sampling, antibiotic penetration, decompression while preventing iatrogenic spread are discussed.