Ewha Med J.  2024 Apr;47(2):e29. 10.12771/emj.2024.e29.

Nontuberculous mycobacterial infection in a sporotricoid distribution in Korea: a case report

• Lee JJ
• Choi YJ
• Byun JY
• Choi YW
• Roh JY
• Choi HY

• KMID: 2556318
• DOI: http://doi.org/10.12771/emj.2024.e29

Abstract

Nontuberculous mycobacterial infections, which are often acquired from environmental sources such as water and soil, exhibit a variety of cutaneous manifestations that frequently lead to misdiagnoses and delays in treatment. A 77-year-old woman presented with multiple skin lesions in a sporotricoid distribution on her right leg, which persisted despite standard antibiotic treatments. Based on the skin biopsy, revealing granulomatous inflammation with acid-fast bacilli, and PCR testing, a nontuberculous mycobacterial infection was diagnosed. Antimycobacterial drug combinations, including clarithromycin, isoniazid, and rifampicin for 4 months, complete the skin lesion's clearance. This case underscores the need for heightened suspicion and the use of appropriate diagnostic techniques, including tissue biopsies and molecular methods such as PCR.

Keyword

Anti-bacterial agents; Biopsy; Nontuberculous mycobacteria; Polymerase chain reaction; Republic of Korea

Figure

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  Fig. 1. Multiple erythematous to maroon-colored crusted deep nodules were arranged linearly on the right leg. Informed consent was obtained for the publication of this case report and accompanying images.

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  Fig. 2. Histological findings. (A,B) Granulomatous inflammation was observed in the dermis and subcutaneous tissue (hematoxylin and eosin: A, ×100; B, ×200). (C) The Ziehl-Neelsen stain revealed acid-fast bacilli (×400). Informed consent was obtained for the publication of this case report and the accompanying images.

Reference

References

1. Sethi A. Tuberculosis and infections with atypical mycobacteria. In. Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ, editors. editors. Fitzpatrick’s dermatology in general medicine. 9th.ed. New York: McGraw-Hill;2019. p. p. 2870–2871.

2. Jogi R, Tyring SK. Therapy of nontuberculous mycobacterial infections. Dermatol Ther. 2004; 17(6):491–498. DOI: 10.1111/j.1396-0296.2004.04051.x. PMID: 15571497.

3. Gonzalez-Santiago TM, Drage LA. Nontuberculous mycobacteria: skin and soft tissue infections. Dermatol Clin. 2015; 33(3):563–577. DOI: 10.1016/j.det.2015.03.017. PMID: 26143432.

4. Weedon D. Weedon’s skin pathology. 3rd ed. London: Churchill Livingstone;2010. p. p. 560.

5. Franco-Paredes C, Marcos LA, Henao-Martínez AF, Rodríguez-Morales AJ, Villamil-Gómez WE, Gotuzzo E, et al. Cutaneous mycobacterial infections. Clin Microbiol Rev. 2018; 32(1):e00069-18. DOI: 10.1128/CMR.00069-18. PMID: 30429139. PMCID: PMC6302357.

6. Palenque E. Skin disease and nontuberculous atypical mycobacteria. Int J Dermatol. 2000; 39(9):659–666. DOI: 10.1046/j.1365-4362.2000.00821.x. PMID: 11044189.

7. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007; 175(4):367–416. DOI: 10.1164/rccm.200604-571ST. PMID: 17277290.