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Tenosynovitis Associated With “Noodling” for Catfish

We believe your readership will be interested in the case of a patient recently seen at our facility. A 50-year-old man presented with a swollen middle finger. Six months prior, he was engaged in “noodling” for catfish in brackish water in Florida. Noodling is a popular practice whereby the fisherman inserts his bare hand into the catfish's toothless mouth underwater, causing the fish to latch onto the fisherman's hand, and then captures it. During this process, he sustained an injury to the left third finger. One month later, the finger became red and moderately swollen. Three months afterward, the finger had worsening pain and function, for which he had a steroid injection at an outside facility. He then developed an ulceration at the site of the initial injury (Fig. 1) and was referred to us. A magnetic resonance imaging scan was obtained, which showed extensive, severe tenosynovitis of the left third finger tendon sheath. The patient was taken for incision and drainage of the left third digit tendon. Intraoperatively, there was diffuse soft tissue swelling, without purulent collections, and the flexor tendons were diffusely indurated and tenosynovitic. The finger was debulked of material with care to avoid iatrogenic injury to the tendons, nerves, arteries, and the A2 and A4 pulleys. Histopathologically, the lesion showed chronic lymphohistiocytic and granulomatous inflammation. Mycobacterial cultures revealed heavy growth of M. Mycobacterium marinum. He was treated with rifampin and clarithromycin, with significant improvement in pain and digit function at 5 months (Fig. 1).