Gordonia bronchialis chronic tenosynovitis of the right wrist and hand in an immunocompetent patient: A case report.

Gordonia bronchialis is a rare aerobic, gram-positive, weakly acid-fast actinomycete that is increasingly recognized as a human pathogen following advances in microbiologic identification. However, it remains frequently misidentified because of phenotypic overlap with Mycobacterium and Nocardia species. Musculoskeletal infections caused by this organism are exceptionally uncommon. We report a 67-year-old immunocompetent male farmer who presented with a one-year history of progressive swelling and functional impairment of the right wrist and hand. Magnetic resonance imaging demonstrated chronic flexor tenosynovitis with extensive rice body formation. The patient underwent open surgical tenosynovectomy. Routine bacterial, fungal, and molecular investigations were negative. Synovial tissue submitted for mycobacterial culture yielded slow-growing colonies after prolonged incubation, which were identified as G. bronchialis using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Prolonged oral antimicrobial therapy with amoxicillin-clavulanate, doxycycline, and ciprofloxacin resulted in marked clinical improvement without recurrence. This case highlights G. bronchialis as a rare cause of chronic tenosynovitis mimicking tuberculous infection and underscores the importance of extended culture incubation and advanced diagnostic techniques in evaluating indolent, culture-negative musculoskeletal infections.