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Empirical treatment of highly suspected nontuberculous mycobacteria infections following aesthetic procedures.

Kim HR, Yoon ES, Kim DW, Hwang NH, Shon YS, Lee BI, Park SH - Arch Plast Surg (2014)

Bottom Line: Delayed management may lead to destructive results.One patient showed an uncommon Stenotrophomonas infection, which was successfully treated.NTM should be considered in the differential diagnosis of an unusual skin and soft-tissue infection.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic Surgery and Reconstructive Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Infection caused by nontuberculous mycobacteria (NTM) has been increasing. Awareness of this infection is crucial yet problematic. Delayed management may lead to destructive results. We empirically treated a series of patients with clinical suspicion of NTM infection prior to the identification of the pathogen.

Methods: A total of 12 patients who developed surgical site infections between January 2011 and February 2014 were reviewed. Patients with a skin and subcutaneous infection resistant to standard management over two weeks, and previous history of aesthetic procedures within three months were regarded as highly suspected of having an NTM infection. A variety of diagnostic modalities were examined simultaneously, along with starting empirical treatment including a combination of clarithromycin and moxifloxacin, and surgical debridement.

Results: All wounds healed completely within 4 weeks. The mean follow-up duration was 7.2 months, and none of the patients developed relapse. Specific NTM pathogens were identified in six patients. Eight patients showed caseating granuloma implying an NTM infection. One patient showed an uncommon Stenotrophomonas infection, which was successfully treated. Three patients had no evidence of a pathogen despite repeated microbial tests. Complications such as scarring, pigmentation, and disfigurement were common in all the patients.

Conclusions: NTM should be considered in the differential diagnosis of an unusual skin and soft-tissue infection. We propose an empirical regimen of clarithromycin and moxifloxacin as an efficient treatment option for an NTM infection.

No MeSH data available.


Related in: MedlinePlus

Case 3A 50-year-old woman who underwent autologous fat grafting on her cheek showed erythematous nodules and purulent discharge. (A) Before treatment. (B) Six months after treatment.
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Figure 5: Case 3A 50-year-old woman who underwent autologous fat grafting on her cheek showed erythematous nodules and purulent discharge. (A) Before treatment. (B) Six months after treatment.

Mentions: A 50-year-old woman went through autologous fat grafting and presented multiple erythematous nodules on the left cheek (Fig. 5A). One month after the procedure, lesions developed on the left side of her face. She visited our hospital one month after lesion development. Gram staining and culture were negative. Staining for AFB and cultures for M. tuberculosis and NTM were performed along with a microscopic study. The AFB staining and the culture test were negative. Despite a series of negative results, the histopathology result showed a caseating granulomatous inflammation, which initially led to the assumption that this case was an NTM infection. Incision, drainage, and curettage were performed on the day of the clinic visit, and two additional surgical debridement procedures followed. As a result, the patient's symptoms improved within 2 weeks. The patient was given empirical antibiotics of oral clarithromycin (500 mg, q 12 hours) and moxifloxacin (400 mg/day) for six weeks since the first day of visit, and she stopped medication after the negative result of the NTM culture was confirmed. She was followed-up for 8 months without relapse; however, a depressed, contracted scar remained (Fig. 5B).


Empirical treatment of highly suspected nontuberculous mycobacteria infections following aesthetic procedures.

Kim HR, Yoon ES, Kim DW, Hwang NH, Shon YS, Lee BI, Park SH - Arch Plast Surg (2014)

Case 3A 50-year-old woman who underwent autologous fat grafting on her cheek showed erythematous nodules and purulent discharge. (A) Before treatment. (B) Six months after treatment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4228222&req=5

Figure 5: Case 3A 50-year-old woman who underwent autologous fat grafting on her cheek showed erythematous nodules and purulent discharge. (A) Before treatment. (B) Six months after treatment.
Mentions: A 50-year-old woman went through autologous fat grafting and presented multiple erythematous nodules on the left cheek (Fig. 5A). One month after the procedure, lesions developed on the left side of her face. She visited our hospital one month after lesion development. Gram staining and culture were negative. Staining for AFB and cultures for M. tuberculosis and NTM were performed along with a microscopic study. The AFB staining and the culture test were negative. Despite a series of negative results, the histopathology result showed a caseating granulomatous inflammation, which initially led to the assumption that this case was an NTM infection. Incision, drainage, and curettage were performed on the day of the clinic visit, and two additional surgical debridement procedures followed. As a result, the patient's symptoms improved within 2 weeks. The patient was given empirical antibiotics of oral clarithromycin (500 mg, q 12 hours) and moxifloxacin (400 mg/day) for six weeks since the first day of visit, and she stopped medication after the negative result of the NTM culture was confirmed. She was followed-up for 8 months without relapse; however, a depressed, contracted scar remained (Fig. 5B).

Bottom Line: Delayed management may lead to destructive results.One patient showed an uncommon Stenotrophomonas infection, which was successfully treated.NTM should be considered in the differential diagnosis of an unusual skin and soft-tissue infection.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic Surgery and Reconstructive Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Infection caused by nontuberculous mycobacteria (NTM) has been increasing. Awareness of this infection is crucial yet problematic. Delayed management may lead to destructive results. We empirically treated a series of patients with clinical suspicion of NTM infection prior to the identification of the pathogen.

Methods: A total of 12 patients who developed surgical site infections between January 2011 and February 2014 were reviewed. Patients with a skin and subcutaneous infection resistant to standard management over two weeks, and previous history of aesthetic procedures within three months were regarded as highly suspected of having an NTM infection. A variety of diagnostic modalities were examined simultaneously, along with starting empirical treatment including a combination of clarithromycin and moxifloxacin, and surgical debridement.

Results: All wounds healed completely within 4 weeks. The mean follow-up duration was 7.2 months, and none of the patients developed relapse. Specific NTM pathogens were identified in six patients. Eight patients showed caseating granuloma implying an NTM infection. One patient showed an uncommon Stenotrophomonas infection, which was successfully treated. Three patients had no evidence of a pathogen despite repeated microbial tests. Complications such as scarring, pigmentation, and disfigurement were common in all the patients.

Conclusions: NTM should be considered in the differential diagnosis of an unusual skin and soft-tissue infection. We propose an empirical regimen of clarithromycin and moxifloxacin as an efficient treatment option for an NTM infection.

No MeSH data available.


Related in: MedlinePlus