Mycobacterium abscessus Infection after Breast Lipotransfer: A Report of 2 Cases

Abstract

Summary: Mycobacterium abscessus is a rare, non-tuberculous, rapidly growing mycobacterium. Although it has been usually associated with chronic pulmonary infections in cystic fibrosis patients, the second most frequent infection sites are the skin and subcutaneous tissue. Most of the cutaneous infections described in the literature occur secondary to cosmetic invasive procedures, many of them in the context of medical tourism. Its atypical presentation and antibiotic-resistant nature make its diagnosis and therapeutics challenging. In this case report, we present 2 cases of M. abscessus infections secondary to breast lipotransfer reported in the same private center. Case 1 patient underwent surgery to treat scar contracture resulting from previous quadrantectomy. Case 2 patient underwent breast augmentation with lipotransfer. Both of them developed lesions in the breast and in the donor site (abdomen). The therapeutic regimen used was amikacin (1 g/24 h) + tigecycline (50 mg/12 h). In case 1, we performed a simple mastectomy, and in case 2, periodical ultrasound-guided drainages were performed as additional procedures. To our knowledge, these are the first 2 cases that describe an infection secondary to breast lipotransfer. The aim of our report was to illustrate the presentation, diagnosis, therapeutic management, and strategies available to prevent this complication.

Vacuoles in the Breast: A Histologic Clue for an Unusual Presentation of an Atypical Organism

“…Thus, the presence of granulomatous inflammation and positive FITE and AFB stains, in this case, is an important distinguishing characteristic, which raised our suspicion for NTM infection, and subsequently prompted clinicians to obtain cultures. The finding of vacuoles in the dermal infiltrate has been noted to be associated with M. abscessus in previous studies, and the organism is usually located within the vacuoles and admixed with inflammatory cells [ 11 - 14 , 21 ]. The origin of these lipid-like vacuoles remains unknown, and there are several theories about their formation.…”

“…Diagnosis is often delayed until a high index of suspicion is raised by either persistent infection despite antibiotic treatment, or histologic or microbiologic findings offering a clue [11]. Histologically, the presence of vacuoles and granulomatous inflammation has been reported as a finding highly suspicious for M. abscessus infection and should prompt clinicians to order tissue cultures [11][12][13][14]. In this paper, we report a case of breast abscess due to M. abscessus in a patient with the absence of known risk factors such as trauma or cosmetic surgery, in which histological findings and cooperation between clinicians, surgical pathologists, and clinical microbiologists were key to arriving at the correct diagnosis.…”

Medical Tourism in Aesthetic Breast Surgery: A Systematic Review

“…Removal of unilateral implant 5 days Asymmetrical breast- one implant in situ Estonia 46 female BBA and mastopexy 1. Wound infection nil 2 days Miguel et al [ 27 ] Case series 2020 Spain Peru 2 66 female Oncoplastic scar contracture revision with fat grafting 1. Breast ulcerative lesions (mycobacterium abscessus) 2. long term IV antibiotics 1.…”

“…In addition, travelling to foreign countries exposes patients to a wider variety of pathogenic microorganisms, particularly rarer pathogens which are harder to culture, diagnose and treat. An important example of this was the identification of various Mycobacterium species following aesthetic surgery in the Dominican Republic [ 10 , 12 , 14 , 17 , 21 , 22 , 27 ]. Mycobacterium infection led to abscess formation, skin necrosis and the need for complex debridement and reconstruction in these patients after difficulty with diagnosis.…”

Postoperative infection mycobacterium abscessus associated with liposuction and autologous fat grafting: A narrative review

“…Sometimes, patients felt fatigued or uncomfortable [19,20]. Other patients could have a sense of burning hot or ulcers at the surgical sites [10,11,21].…”