Bone marrow infection with Mycobacterium fortuitum in a diabetic patient

Incidence and prevalence of Mycobacterium fortuitum infection vary greatly by location and death is very rare except in disseminated disease in immunocompromised individuals. We present what we believe is the first case of bone marrow infection with Mycobacterium fortuitum in an HIV negative patient. Bone marrow examination revealed presence of numerous acid fast bacilli which were confirmed as Mycobacterium fortuitum on culture and by molecular analysis. Patient was managed successfully with amikacin and ciprofloxacin.     

Mycobacterium fortuitum infection in a patient with a penile prosthesis. Case report

A 47-year-old male with a Mentor penile prosthesis presented with purulent drainage eight months after implantation. In addition to other organisms, routine cultures from the implant site yielded Mycobacterium fortuitum, an association never reported previously in the literature. Infection resolved with removal of the implant and antibiotic therapy.     

Bilateral knee periprosthetic infection with Mycobacterium fortuitum

Periprosthetic infections after total joint arthroplasty are infrequent but potentially devastating complications. Gram-positive bacteria is the typical causative organism. However, uncommon sources such as Mycobacterium fortuitum have been documented in the literature. We report a case, the first to our knowledge, of bilateral infections involving this organism after total knee arthroplasty. M. fortuitum is notoriously resistant to many standard antibacterial medications, and a delay in initial diagnosis due to inadequate incubation time has been reported. In poor surgical candidates, long-term antibiotic suppression may be a viable alternative.     

Mycobacterium fortuitum associated with fasciotomy in an immunocompetent patient

A 40-year-old woman presented with a skin disease, characterized by confluent erythematous nodules and purulent material discharges, which affected the right arm. A Ziehl–Nielsen stain of purulent material revealed the presence of acid-fast bacilli. The isolated microorganism was identified by standard biochemical procedures as a member of the Mycobacterium fortuitum group. Molecular identification performed by amplification and sequencing of the 16S rRNA revealed 100% identity with strains of M. fortuitum. The following report reveals an extensive cutaneous affection caused by M. fortuitum in a non-predisposed immunocompetent patient.     

Encapsulating peritoneal sclerosis in a peritoneal dialysis patient presenting with complicated Mycobacterium fortuitum peritonitis

Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication seen in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysisAPD after prolonged duration on dialysis. Patients usally present with vague complaints of abdominal pain, vomitting, diarrhea, weight loss and change in peritoneal transport characte-ristics. High degree of suspicion is needed in PD patients who have been on dialysis for prolonged duration and have been using high-concentrated dialysis fluid. Mycobacterium fortuitum (MF) is a rapidly growing, non-tuberculous mycobacterium that has rarely been reported as a pathogen causing peritonits in patients on PD. We report a case of CAPD presenting with culture-negative peritonits, which, on specific culture, grew MF and, on radiological evaluation, showed diagnostic features of EPS.     

Mycobacterium fortuitum breast infection following nipple-piercing, mimicking carcinoma

We reviewed a rare breast infection occurring 4 months after nipple piercing. Clinical examination suggested carcinoma. Mycobacterium fortuitum was eventually isolated after surgical biopsy and debridement. Antibiotic therapy was initiated intravenously using two drugs and oral therapy was continued for 6 months. A contralateral mycobacterial lesion emerged and was excised along with a residual fibrotic nodule at the original biopsy site. When adequate sampling of a complex and suspicious breast mass is benign and initial bacterial cultures are sterile, mycobacterial infection should be considered, particularly when there is a history of previous nipple piercing procedures.     

Mycobacterium fortuitum sternal wound infection following mitral valve replacement

Mycobacterium fortuitum infection of the sternum following cardiac surgery is a rare occurrence.It is usually diagnosed late and has a considerable mortality. We present a female patient with mycobacterium fortuitum sternal wound infection following mitral valve replacement, who was successfully managed with radical surgical debridement combined with multidrug antibiotics. Multidrug antibiotic therapy is essential because of the emergence of resistant strains.     

Thoracoabdominal aortic aneurysm associated with abdominal aortic and visceral arterial occlusion in a hemodialysis patient

We report an extremely rare case of saccular thoracoabdominal aortic aneurysm associated with high abdominal aortic occlusion including the superior mesenteric and bilateral renal arteries in a patient requiring hemodialysis. Successful repair of the aneurysm and concomitant revascularization of the lower extremities was achieved using femoro-femoral bypass for perfusion of the lower body along with the visceral and intercostal arteries.     

Mycobacterium fortuitum: an iatrogenic cause of soft tissue infection in surgery

BACKGROUND: Mycobacterium fortuitum is an uncommon cause of soft tissue infections. Treatment is often inadequate with persistence of infection unless the aetiological agent and its antibiotic sensitivity are accurately established. METHODS: Medical records of 23 patients with chronic soft tissue infection caused by M. fortuitum over a 12-year period from 1991 to 2002 were studied. RESULTS: In 20 patients the cause was iatrogenic, following intramuscular injections (12), laparoscopy (5) and other surgical procedures (3) and in three patients discharging sinuses developed spontaneously. Patients presented with recurrent abscesses or chronic discharging sinuses that did not respond to conventional surgical drainage. The diagnosis was established by isolating M. fortuitum from the tissues in all cases. The treatment consisted of a more aggressive surgical intervention in form of excision, debridement and extensive lay open with curettage and prolonged administration of appropriate antibiotics. The organism showed maximum sensitivity to amikacin and ciprofloxacin. Healing occurred in all cases. Three patients suffered recurrences: two responded to further debridement and antibiotics and are well at 2 and 5 years, respectively. CONCLUSION: A high index of suspicion based on clinical presentation is essential to diagnose M. fortuitum as a cause of soft tissue infection. Treatment involves aggressive surgical debridement and administration of combination antibiotics based on sensitivity, which should be continued for a period that will ensure complete healing and prevent recurrence.     

Mycobacterium fortuitum skin infection as a complication of anabolic steroids: a rare case report

Mycobacterium fortuitum is a rare cause of recurrent skin abscesses in an immunocompetent person. We report the case of a 37-year-old man presenting with multiple recurrent non-healing skin abscesses. Culture of the abscess wall yielded growth of M fortuitum. In our case, we highlight the association of anabolic steroids with non-tuberculous mycobacterial skin abscesses that fail to resolve despite repeated drainage.     

Mycobacterium fortuitum infection following primary achilles tendon debridement with flexor hallucis longus augmentation: a case report

Mycobacterium fortuitum (M. fortuitum), a rapidly growing non-tuberculous mycobacterium is a well-recognized, yet uncommon cause of soft tissue infection. The incidence of post surgical wound infections from this organism is increasing. The presentation of infection is atypical and failure to consider this pathogen can cause diagnostic delay and increased morbidity. Achilles tendon debridement with FHL augmentation is commonly used in patients with chronic Achilles tendinosis. Wound-edge necrosis is the most common surgical complication of this procedure, and superficial and deep infections are potentially devastating complications. We report the case of a patient who underwent Achilles tendon debridement with flexor hallucis longus augmentation, whose postoperative course was complicated by a deep M. FORTUITUM infection. Critical to the identification and ultimate treatment of this particular pathogen is the utilization of appropriate intraoperative cultures and microbiologic testing. In addition, repeat aggressive irrigation and debridement procedures coupled with removal of foreign materials and the appropriate use of prolonged antibiotic therapy can result in a successful long-term outcome.     

Mycobacterium fortuitum lung abscess treated with ciprofloxacin.

Mycobacterium fortuitum rarely causes lung disease. Although treatment in the past has included intravenous antibiotics, this is the first report of a Mycobacterium fortuitum lung abscess that resolved with a prolonged course of oral ciprofloxacin alone. There is no evidence of recurrence 14 months after the end of treatment.