Cutaneous infection with Mycobacterium abscessus

Cutaneous infection with rapidly growing mycobacteria is uncommon and diagnosis may be difficult. However, the histopathological features are distinctive and may aid diagnosis. The three pathogenic species, Mycobacterium fortuitum, M. chelonae and M. abscessus, show major differences in their antimicrobial sensitivities, and species identification is therefore important. We describe a case of infection with M. abscessus, and discuss the clinical and pathological features of such infections, and approaches to their treatment.     

Cutaneous Mycobacterium abscessus infection following hair transplant

A 28‐year‐old man presented with a 10‐day history of scalp nodules. He had undergone hair transplantation 2 months previously. Incision and drainage of one of the nodules yielded gelatinous material, which was sent for microscopy and culture, including low‐temperature culture. After 2 weeks of incubation, culture of the nodule yielded acid‐ and alcohol‐fast bacilli, which were identified as Mycobacterium abscessus, a rapidly growing, nontuberculous mycobacterium, which has been reported to cause cutaneous, soft tissue and respiratory infections following trauma, surgery or injection with nonsterile needles. A high index of suspicion is therefore needed in patients who present with cutaneous infections after cosmetic dermatological procedures, including hair transplantation.     

Subcutaneous infection with Mycobacterium abscessus in a renal transplant recipient

Transplant recipients show a high incidence of infections, often with atypical manifestations mainly because of drug-related immunosuppression. Mycobacterial infections can be life-threatening in immunosuppressed patients due to the risk of dissemination. There have been only few reports of cutaneous infections with Mycobacterium abscessus among immunosuppressed patients. We present a rare case with a sporotrichoid skin infection with M. abscessus in a renal recipient. The value of immunohistochemical detection of mycobacteria using an anti-BCG antibody in the diagnostic work-up skin biopsies is demonstrated. Long-term antibiotic treatment resulted in complete remission, although recurrences with atypical presentation were observed.     

Mycobacterium abscessus wound infection

We report an isolated case of wound infection due to Mycobacterium abscessus following minor cutaneous surgery. The patient had routine skin cancer surgery in a private dermatology practice setting. He presented 2 weeks later with a wound infection which failed to respond to cephalexin. The patient reported that he had walked through salt water and bushes with exposed surgical wounds 1 week postoperatively. Tissue cultures later grew M. abscessus. The patient was successfully treated with oral clarithromycin 500 mg qid of 6 months duration.     

A Case of Skin and Soft Tissue Infection Caused by Mycobacterium abscessus

Mycobacterium abscessus (M. abscessus) is an acid-fast bacillus that''s classified as a pathogenic "rapid growing" nontuberculous mycobacteria. It is an uncommon cause of human disease, but it can cause skin and soft tissue infection after skin injury following inoculation, minor trauma and surgery. The single most important factor for determining the course and prognosis of a M. abscessus infection is the underlying immune status of the host. We report here on a 71-year-old female who presented with multiple painful erythematous cutaneous nodules on her left forearm. She had diabetes mellitus and had taken oral steroid by herself for two years because of her osteoarthritis. Histologically, granulomas and inflammatory cell infiltration were observed and M. abscessus was identified via the mycobacterial culture. We performed curettage and drainage, followed by 6 months of oral clarithromycin and the patient''s disease completely healed.     

Mycobacterium abscessus infection complicating a professional tattoo

A healthy 23-year-old man presented with a tender papular eruption confined to the grey pigment of a recently acquired professional tattoo. Atypical mycobacterial infection was suspected and culture of a tissue specimen grew Mycobacterium abscessus. He was successfully treated with minocycline and subsequently, clarithromycin. We present a brief review of M. abscessus infection, with a particular focus on its role in nosocomial infections and in the post-tattoo setting.     

注射美容致皮肤脓肿分枝杆菌感染三例并文献复习

目前有多篇外科手术、美容手术、美容注射、文身后发生皮肤脓肿分枝杆菌感染的报道,更有在整容手术或抽脂的诊所中发生爆发事件的报道,其中一些病例的发生与未经批准的药物注射和不规范的操作相关,本文报道3例美容注射后罹患皮肤脓肿分枝杆菌感染的病例并复习相关文献.     

A Case of Cutaneous Mycobacterium Chelonae Abscessus Infection in a Renal Transplant Patient

Abstract Background: Mycobacterium chelonae is an atypical "fast-growing Mycobacteria" that is a rare cause of human infection. There have been several reports of cutaneous infection among immunosuppressed patients, as well as in immunocompetent individuals following trauma. Most cases to date seem to have occurred among renal transplant recipients, raising the possibility that there is something inherent to the renal transplant patient that increases their susceptibility more than other immunocompromised patients. Objective: The differential diagnosis of subcutaneous nodules distributed in a sporotrichoid pattern is extensive, particularly in an immunocompromised host. Although several cases of cutaneous M. chelonae abscessus infection have been reported among both immunosuppressed and immunocompetent patients, the clinical presentation has varied, and few cases have reported the appearance of lesions in a sporotrichoid pattern. We present a case of a renal transplant patient with a reported history of trauma to the lower extremities, who presents with subcutaneous nodules distributed in a sporotrichoid pattern. The patient is found to have M. chelonae abscessus infection, fails several treatment regimens, and presents with a recurrence. The literature of M. chelonae infection is reviewed, and the various treatment options are discussed. Methods: An initial skin biopsy was stained with Hematoxylin and Eosin and revealed deep dermal abscesses with acid-fast bacilli in clusters. The culture became positive for Mycobacterium chelonae abscesses in four days and was found to be sensitive to multiple antibiotics. The patient underwent surgical excision of 14 nodules, which revealed findings consistent with the skin biopsy, and was subsequently treated with the appropriate antibiotics. Results: Despite treatment with a full course of an organism-sensitive antibiotic regimen, the patient returned with persistent and recurrent nodules six weeks later. The patient was then treated as an inpatient with a seven-week course of intravenous antibiotics and was discharged home on a combined intravenous and oral regimen. Conclusion: Although M. chelonae abscessus is an extremely rare cause of infection among humans, there seems to be a predominance of cases reported among renal transplant patients. The explanation for this is not entirely clear; however, the organism must be considered as a cause of infection in any renal transplant recipient who presents with subcutaneous nodules. Eradication of the organism presents a tremendous challenge to the clinician, and, as presented here, even with appropriate antibiotics, there is a high rate of recurrence.     

Cutaneous Mycobacterium fortuitum Infection: Successfully Treated with Amikacin and Ofloxacin Combination

Cutaneous infections caused by atypical mycobacteria are uncommon and the diagnosis can be missed unless there is strong clinical suspicion supported by laboratory confirmation. We report a case of chronic discharging sinus caused by Mycobacterium fortuitum in a young healthy immunocompetent individual. The patient recovered completely following amikacin and ofloxacin therapy.     

Cutaneous Mycobacterium massiliense Infection of the Sole of the Feet

Mycobacterium massiliense which is recognized as a separate species from M. abscessus is little known regarding its clinical patterns and the response to treatment. We present a case of a localized cutaneous infection due to M. massiliense of the sole associated with acupuncture. M. massiliense was identified via polymerase chain reaction-hybridization analysis. We treated the patient with single-drug therapy consisting of clarithromycin for 4 months and the patient showed a significant response to this treatment.     

脓肿分枝杆菌致全身播散性皮肤感染一例

目的 报道1例罕见的全身播散性脓肿分枝杆菌皮肤感染.方法 对患者作全面临床检查.应用流式细胞仪检测患者细胞免疫水平,同时进行组织病理检查、组织培养.用PCR-RFIJP、基因测序方法对分离自患者皮损的分枝杆菌做鉴定.结果 患者女,22岁,1年多前,无明显诱因面颈部出现对称性红斑,并在此基础上渐出现丘疹、结节和斑块,逐渐扩展至躯干四肢;患者CD4⁺T细胞低于正常,HIV抗体检测阴性.对皮损进行两次多管体外培养,3～5天后,Löwenstein-Jensen培养基上(37℃和32℃)出现阳性菌落.PCR-RFLP比较分析发现,临床分离株的酶切(BstEⅡ和HaeⅢ)图谱与脓肿分枝杆菌的酶切图谱相符合;对临床分离株的hsp65、16S rRNA基因进行了序列分析,发现该二序列与脓肿分枝杆菌同源性最接近,分别是99.75%和100%.予以患者口服利福平、异烟肼、左氧氟沙星、克拉霉素,胸腺肽肌内注射,2个月后皮损明显好转.复查该患者的免疫状况,CD4⁺T细胞已在正常范围;6个月后颈部、躯干及四肢皮损基本痊愈.结论 结合表型特征、DNA酶切图谱和序列分析,临床分离株符合脓肿分枝杆菌;抗生素联合化疗辅以免疫调节剂综合治疗有效.     

Pulmonary Mycobacterium abscessus infection-induced erythema induratum

Erythema induratum (EI) is clinically characterized by recurrent crops of tender nodules on the lower legs and lobular panniculitis with granulomatous inflammation and pathologically characterized by vasculitis and focal fat necrosis. Currently, many authors consider EI to be a multifactorial disorder with diverse causes, including Mycobacterium tuberculosis and hepatitis C infection. Here, we report a case of a 65-year-old female with a 1-year history of recurrent crops of tender nodules and plaques on her bilateral lower legs. In addition, she had suffered from a chronic cough with sputum for 1 year and had contact history with pulmonary nontuberculous mycobacterial infection from her husband. The histopathological findings of the skin biopsies were consistent with the diagnosis of EI. Chest computed tomography revealed multiple lymphadenopathy and two sets of sputum cultures showed M. abscessus. After 2 months of anti-nontuberculous mycobacterial therapy with ciprofloxacin, the skin lesions resolved completely and there was no recurrence within the following year.     

Cutaneous silica granuloma in a child

A 12-year-old girl had a 4-year history of two asymptomatic, sharply demarcated, granulomatous lesions on her face. The lesions did not respond to topical steroids and histopathologic examination of biopsy specimens showed granulomatous inflammation. Since cutaneous leishmaniasis is endemic where the patient lived, she was diagnosed as chronic cutaneous leishmaniasis but did not respond to meglumine antimoniate treatment. Reexamination of the biopsy specimens under polarized light revealed numerous birefringent crystalline particles, and cutaneous silica granuloma was the final diagnosis. The lesions were treated with intralesional triamcinolone acetonide and completely disappeared. We report this case of cutaneous silica granuloma, which is unusual in children, and emphasize the importance of polarized light microscopic examination of granulomatous skin diseases.     

Cutaneous leishmaniasis in a child treated with oral fluconazole

We report a case of cutaneous leishmaniasis in a 3‐year‐old West African girl with a 3‐month history of multiple disfiguring, infiltrated, ulcerating and variably necrotic granulomatous plaques on the limbs and face that occurred after swimming in a river approximately 6 weeks before arriving in Australia. A diagnosis of cutaneous leishmaniasis, a protozoal zoonosis usually transmitted by the Phlebotomus species of sandfly, was considered. The clinico‐pathological features were consistent with Leishmania major infection, known to be the major endemic species causing cutaneous leishmaniasis in the country of origin. Because of the presence of lesions on the face, active treatment was instituted. Continuing resolution of all lesions over 6 weeks was noted to occur with cribiform scarring with the use of oral fluconazole 150 mg daily. Oral fluconazole appears to be emerging as a therapy for uncomplicated cutaneous leishmaniasis, with advantages particularly important in paediatrics.