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To the Editor—Mycobacterium arupense, a slowly growing nonchromogenic mycobacterium, was first isolated from clinical samples in 2006 [1]. The clinical significance of this novel organism remains unknown.

A 54-year-old woman presented with swelling and pain of the left middle finger and a tender nodule in the middle of her palm. Six months earlier, she had been involved in a motorcycle traffic accident and noted a mildly tender nodule on her left palm 1 month later. Swelling of the third distal phalanx then developed, and an incision was made on the palm after a diagnosis of trigger finger. The condition deteriorated after surgery, and a new nodule developed on the palm. She denied having contact with contaminated water or handling fish. Physical examination revealed diffuse swelling on the left middle finger and 2 tender nodules on the middle of her palm (figure 1). Tenosynovitis was suspected, and a biopsy was performed of a specimen obtained by incision. Pathological examination revealed suppurative granulomatous inflammation with Langhans giant cells, but results of acid-fast staining were negative. The lesions continued to progress despite empirical treatment, for 2 weeks, with minocycline (200 mg daily), itraconazole (400 mg daily), clarithromycin (1000 mg daily), rifampicin (450 mg daily), and ciprofloxacin (500 mg daily). Two months later, culture of a skin specimen grew acid-fast bacilli, and an unidentified Mycobacterium species was reported with test results. Because of the deterioration of the patient's clinical condition, synovectomy and debridement were performed. The patient then received treatment with clarithromycin (500 mg every 12 h), moxifloxacin (400 mg daily), rifabutin (300 mg daily), ciprofloxacin (400 mg every 12 h), and ethambutol (1000 mg daily) for 6 months, and her condition improved.

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