Surgical Site Infection Caused by Mycobacterium Septicum Following Blepharoplasty

Abstract

Background: M fortuitum and M chelonae are commonly reported in surgical site infections caused by nontuberculous mycobacterium, but M septicum is rarely known. Herein, the authors report the first case of surgical site infection caused by M septicum in an immunocompetent patient after blepharoplasty. Methods: A 37-year-old woman had persisting bilateral masses on the upper eyelids at 3 months after a blepharoplasty. The excision and revision were performed in a local clinic with the administration of the empirical antibiotic (clarithromycin) for 2 months, but the masses recurred. The patient was referred to the authors’ hospital after the steroid was injected. As the right eyelid skin was very thin with the pus pocket, curettage was performed, while the mass on the left eyelid was completely excised. A bacterial, Acid Fast Bacilli culture with antibiotic susceptibility testing, and a DNA-polymerase chain reaction test were performed. Results: The polymerase chain reaction test identified M septicum. The antibiotic treatment was delayed to identify the susceptibility to antibiotics, but the Acid Fast Bacilli culture result showed no growth. In the meantime, the mass on the right eyelid recurred. Levofloxacin and clarithromycin were administered for 6 months in consultation with the Division of Infectious Diseases. Then the mass was excised. There was no recurrence after 1 year of follow-up. Conclusion: There are a few reports of M septicum catheter-related infection and pulmonary disease, but surgical site infection has not been reported. When a localized mass on a surgical site is found, surgeons should consider M septicum infection and find out the pathogen with its antibiotics susceptibility.

Mycobacterium chelonae infection in an immunocompromised patient presenting as multiple papulonodules on the leg

“…M. chelonae is a low-virulence bacterium and is rarely found as a cause of skin infections in immunocompetent and immunocompromised patients. When immunocompetent patients are affected, it is usually following trauma to the skin, which includes both invasive and minimal procedures, intradermal and subcutaneous injections, and minor skin trauma, such as laparoscopic surgery (13), blepharoplasty (14), tattoos (15), mesotherapy (16), pedicures (17), liposuction and lipofilling (18), acupuncture (19), sclerotherapy (20), and contact lens wear (21). M. chelonae infections can also affect immunocompromised patients; for example, cancer patients (22), HIV patients (23), patients with hematological malignancies (24), patients on corticosteroid therapy (25)(26)(27) and biologic therapy, especially on tumor necrosis factor alpha inhibitors (28,29), patients with autoimmune disorders (30), and patients following organ transplantation (31), as was the case in the patient presented (6,32).…”

Nontuberculous Mycobacterium Eyelid Infection after Cosmetic Blepharoplasty: a Case Report

“…However, the incidence is quite low, which is less than 3 per cent of all cases with infected incised wound after surgery. 9 Shin et al (2019) 13 reported a case of a 37-year-old female patient, whose lumps grew on the eyelid three months after blepharoplasty, was sent to a surgery to remove the lumps and found M. Septicum on the lab test. She was then admitted to hospital and was given levofloxacin and clarithromycin for six months.…”

“…From the literature review, it was found that Nontuberculous Mycobacterium eyelid infection occurred rarely, especially after a surgery 13 , the infection found after blepharoplasty were mostly from Staphylococcus group of germs 3,9 .…”