Mycobacterium chelonae infection with multiple cutaneous lesions after treatment with acupuncture

A 58-year-old-woman was first seen in November 1999 with a 4-week history of several tender, deep red or purple, suppurating subcutaneous nodules on the skin of the abdomen, suggestive of a panniculitis ( Fig. 1 ). She had no history of systemic immunosuppression. Three months prior to examination, the patient had treated with acupuncture for obesity. Two biopsy specimens of the nodules were taken and sent for culture and histologic examination. Histology showed a pattern of panniculitis with chronic inflammatory cells mixed with areas of polymorphonuclear abscesses and necrosis ( Fig. 2 ). Culture of the biopsy specimen grew acid fast bacilli within 4 days, later identified with biochemical and molecular tests as Mycobacterium chelonae (subspecies chelonae). Polymerase chain reaction-restriction enzyme pattern analysis (PRA) was used for molecular identification of mycobacteria. In vitro sensitivity tests showed sensitivity to clarithromycin, amikacin, tobramycin, doxycycline and erythromycin and resistance to ciprofloxacin, ofloxacin, trimethoprim-sulfamethoxazole, imipenem and cefoxitin. Oral clarithromycin (500 mg b.d.) was started and after 3 months of therapy the lesions had cleared completely.

Figure 1 Open in figure viewer PowerPoint Abdomen with disseminated subcutaneous erythematous nodules due to M. chelonae after treatment with acupuncture