Pyogenic Flexor Tenosynovitis Caused by Shewanella algae

Pyogenic flexor tenosynovitis is an orthopedic emergency most commonly caused by Staphylococcus aureus and streptococci and occasionally, when associated with water exposure, Mycobacterium marinum. Shewanella algae, a gram-negative bacillus found in warm saltwater environments, has infrequently been reported to cause serious soft tissue infections and necrosis. In this case, S. algae caused complicated flexor tenosynovitis requiring open surgical irrigation and debridement. Flexor tenosynovitis caused by S. algae rapidly presented with all 4 Kanavel cardinal signs as well as subcutaneous purulence, ischemia, and necrosis, thus meeting the requirements for Pang et al group III classification of worst prognosis. Because of its rarity and virulence, S. algae should always be considered in cases of flexor tenosynovitis associated with traumatic water exposure to treat and minimize morbidity appropriately.