Ann Dermatol.  2009 Feb;21(1):84-87. 10.5021/ad.2009.21.1.84.

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

• Kwon YH
• Lee GY
• Kim WS
• Kim KJ

• KMID: 2172076
• DOI: http://doi.org/10.5021/ad.2009.21.1.84

Abstract

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.

Keyword

Mycobacterium abscessus; Skin infection

MeSH Terms

Aged
Bacillus
Clarithromycin
Curettage
Diabetes Mellitus
Drainage
Female
Forearm
Granuloma
Humans
Mycobacterium
Nontuberculous Mycobacteria
Osteoarthritis
Prognosis
Skin
Soft Tissue Infections
Clarithromycin

Figure

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  Fig. 1 Multiple erythematous swollen nodules on the left forearm.

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  Fig. 2 Polymerlase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP) shows 105 bp, 80 bp and 40 bp bands that were compatible with Mycobacterium abscessus.

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  Fig. 3 Note the polymorphonuclear microabscesses in the upper dermis and several epithelioid granulomas in the mid and deep dermis (H&E stain, ×40).

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  Fig. 4 The granuloma consisted of epithelioid cells and lymphoid cells (H&E stain, ×200).

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  Fig. 5 After a 6 month remission period, a similar skin lesion developed on the left forearm.

Reference

1. Moore M, Frerichs JB. An unusual acid-fast infection of the knee with subcutaneous, abscess-like lesions of the gluteal region; report of a case with a study of the organism, Mycobacterium abscessus, n. sp. J Invest Dermatol. 1953. 20:133–169.

2. Fitzgerald DA, Smith AG, Lees A, Yee L, Cooper N, Harris SC, et al. Cutaneous infection with Mycobacterium abscessus. Br J Dermatol. 1995. 132:800–804.

3. Morris-Jones R, Fletcher C, Morris-Jones S, Brown T, Hilton RM, Hay R. Mycobacterium abscessus: a cutaneous infection in a patient on renal replacement therapy. Clin Exp Dermatol. 2001. 26:415–418.

4. Lee SH, Kim KY, Hong SP, Kim MJ, Yang MH, Seou JT. A Mycobacterium Chelonae Subsp. abscessus wound infection after percutaneous endoscopic gastrostomy. Korean J Med. 1997. 53:842–846.

5. Cho JH, Kim MY, Park YM, Kim HO. A case of cutaneous infection due to Mycobacterium abscessus. Korean J Dermatol. 2004. 42:512–515.

6. Choi YL, Lee KJ, Lee DY, Lee ES. A case of skin infection caused by Mycobacterium abscessus. Korean J Dermatol. 2005. 43:852–855.

7. Kim HS, Park HJ, Lee JY, Cho BK. Twelve cases of cutaneous infection by Mycobacterium abscessus: review on its treatment modality. Korean J Dermatol. 2005. 43:1603–1609.

8. Ryu HJ, Kim WJ, Oh CH, Song HJ. Iatrogenic Mycobacterium abscessus infection associated with acupuncture: clinical manifestations and its treatment. Int J Dermatol. 2005. 44:846–850.

9. Wallace RJ Jr, Tanner D, Brennan PJ, Brown BA. Clinical trial of clarithromycin for cutaneous (disseminated) infection due to Mycobacterium chelonae. Ann Intern Med. 1993. 119:482–486.

10. Brantley JS, Readinger AL, Morris ES. Cutaneous Infection with Mycobacterium abscessus in a child. Pediatr Dermatol. 2006. 23:128–131.

11. Inman PM, Beck A, Brown AE, Stanford JL. Outbreak of injection abscesses due to Mycobacterium abscessus. Arch Dermatol. 1969. 100:141–147.

12. Galil K, Miller LA, Yakrus MA, Wallace RJ Jr, Mosley DG, England B, et al. Abscesses due to mycobacterium abscessus linked to injection of unapproved alternative medication. Emerg Infect Dis. 1999. 5:681–687.

13. Rodriguez G, Ortegon M, Camargo D, Orozco LC. Iatrogenic Mycobacterium abscessus infection: histopathology of 71 patients. Br J Dermatol. 1997. 137:214–218.