Mycobacterium abscessus infection after injection of lipolytic enzymes into abdominal fat

The Mycobacterium abscessus complex, a part of the nontuberculous mycobacteria (NTM) group, comprises three subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. boletii^1,2. These microorganisms are known to cause skin and other soft tissue infections following injuries with nonsterile materials^3-5. This study was approved by the Institutional Ethics Committee. A 38-year-old woman presented with painful inflammatory nodules 2 months after receiving injections of lipolytic enzymes into her abdominal fat (Figure 1). The nodules were tender, and the patient reported pus drainage. Despite a 7-day course of cephalexin and moxifloxacin, her condition did not improve. Azithromycin 500 mg and ciprofloxacin 500 mg daily was initiated. The direct acid-fast bacilli (AFB) examination yielded negative, and the histopathological examination revealed deep granulomatous chronic dermatitis with granulation tissue, without evidence of AFB or fungi (Figure 2). However, a culture of the fragment in Lowenstein-Jensen medium and Mycobacteria Growth Indicator Tube broth with automated fluorimetry detected mycobacteria. M. abscessus subsp. abscessus was identified through partial sequencing of the rpoB gene and further analyzed by the GenBank international database. After maintaining the azithromycin for 6 months, the lesions resolved leaving scars (Figure 3). The growing interest in aesthetic procedures has led to a significant increase in NTM infections, making them an emerging public health issue. Such procedures should be performed by qualified medical professionals using aseptic techniques and materials. Public health strategies are needed to prevent morbidity and mortality, and it is crucial to educate the public about these risks.

FIGURE 1:
Multiple erythematous nodules on the abdomen, one of them with ulceration.

FIGURE 2:
a) Histopathology of biopsy showing acanthosis and lymphoplasmacytic infiltrate in the dermis, outlining granulomas (hematoxylin-eosin ×100). b) Detail of the inflammatory infiltrate (hematoxylin-eosin, ×400).

FIGURE 3:
Hyperchromic and atrophic scars after treatment.

ACKNOWLEDGMENTS

There is no specific acknowledgment in this report.

REFERENCES

• ¹
  Lee MR, Sheng WH, Hung CC, Yu CJ, Lee LN, Hsueh PR. Mycobacterium abscessus complex infections in humans. Emerg Infect Dis. 2015;21(9):1638-46.
• ²
  Combalia A, Morgado-Carrasco D, Fustà-Novell X, Mascaró-Galy JM. Abdominal violaceous skin lesions of a 47-year-old woman following a geometric pattern. Enferm Infecc Microbiol Clin (Engl Ed). 2018;36(9):598-9.
• ³
  Dickison P, Howard V, O’Kane G, Smith SD. Mycobacterium abscessus infection following penetrations through wetsuits. Australas J Dermatol. 2019;60(1):57-9.
• ⁴
  Koh SJ, Song T, Kang YA, Choi JW, Chang KJ, Chu CS, et al. An outbreak of skin and soft tissue infection caused by Mycobacterium abscessus following acupuncture. Clin Microbiol Infect. 2010;16(7):895-901.
• ⁵
  Sfeir M, Walsh M, Rosa R, Aragon L, Liu SY, Cleary T, et al. Mycobacterium abscessus Complex Infections: A Retrospective Cohort Study. Open Forum Infect Dis. 2018;5(2):ofy022.

• Financial Support: There was no financial support for the elaboration and development of this case report.

Publication Dates

• Publication in this collection
  22 Sept 2023
• Date of issue
  2023

History

• Received
  15 June 2023
• Accepted
  03 Aug 2023