Complicated skin and soft tissue infection with Mycobacterium fortuitum following excision of a sebaceous cyst in Taiwan

Abstract

Mycobacterium fortuitum group (M. fortuitum), also known as rapidly growing Mycobacteria, can cause pyogenic infections in human beings, most commonly in immunocompromised patients. Herein, we present a 40-year-old immunocompetent male patient who underwent planned excision of a sebaceous cyst in the abdominal wall. He suffered from tender erythematous lesions with purulent discharge around the healing wound that developed 2 weeks after surgery. Gram stain, bacterial and fungal culture results of the wound were negative. A diagnosis of nontuberculous mycobacteria was made from a wound culture from the area of operative debridement, which was subsequently confirmed to be M. fortuitum group using PCR-restriction fragment length polymorphism analysis of the hsp65 gene. The patient received 4 weeks of parenteral imipenem/cilastatin 500 mg every 6 hours and amikacin 500 mg every 12 hours, plus oral clarithromycin 500 mg twice daily, and the wound recovered completely. He was discharged and followed up regularly at our outpatient clinic, and continued taking oral ciprofloxacin and clarithromycin 500 mg twice daily for 6 months. This case highlights the importance of strict aseptic precautions even during minor procedures, and also the characteristics of M. fortuitum infections in immunocompetent patients, which usually develop as localized postsurgical wound infections. We also share our experience in successfully treating a M. fortuitum complicated skin and soft tissue infection.

Disseminated Cutaneous Mycobacterium Fortuitum-Chelonae Complex Infection in a Young, Immunocompetent Patient: A Case Report

“…RGM can cause infections following invasive procedures such as subcutaneous injections of traditional medicine, excision of a sebaceous cyst, Ibrutinib therapy, skin graft, cosmetic surgery, and sclerotherapy of a varicose vein. 1,2,3,4,5 Health-care associated outbreaks is believed to be due to contaminated tap water. Environmental exposure such as gardening has also been shown to cause cutaneous RGM infections.…”

“…In cases with abscess formation, neutrophil predominance may be observed. 1,5,9 The sensitivity of AFB staining is unsatisfactory in majority of RGM cases, although it is a fast and convenient diagnostic method. Therefore, despite being time-consuming, cultures are needed for mycobacteria detection, which also allows susceptibility testing.…”

Rare case of a recurrent juvenile ossifying fibroma of the lumbosacral spine

“…19,25 M. fortuitum surgical site infections require surgical debridement and extended treatment with amikacin and clarithromycin or a fluoroquinolone. 25,43 Spinal JOFs are an exceptionally rare lesion, but they should be in the differential diagnosis of primary spinal tumors. After a histopathological diagnosis, the first line treatment of a JOF is resection.…”

Ribosomal maturation factor (RimP) is essential for survival of nontuberculous mycobacteria Mycobacterium fortuitum under in vitro acidic stress conditions

“…M. fortuitum infections have been reported in immunocompetent individuals indicating increased virulence of the pathogen (Macente et al 2013;Chetchotisakd et al 2000). M. fortuitum infections can be fatal in immunocompromised patients, while recovery of M. fortuitum infections in immunocompetent individuals may also require long term drug treatment regimen (Tsai et al 2016). Co-infection of M. fortuitum along with M. tuberculosis in ocular mycobacteriosis has been reported with no results from antituberculous drug therapy indicating requirement of multidrug treatment for M. fortuitum along with M. tuberculosis (Sharma et al 2017).…”