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Mycobacterium fortuitum skin infections after subcutaneous injections with Vietnamese traditional medicine: a case report.

Lan NP, Kolader ME, Van Dung N, Campbell JI, Tham NT, Chau NV, van Doorn HR, Le DH - BMC Infect. Dis. (2014)

Bottom Line: Iatrogenic skin and soft tissue infections by rapidly growing mycobacteria are described with increasing frequency, especially among immunocompromised patients.Moreover, we present dilemmas faced in less resourceful settings, influencing patient management.This case illustrates the pathogenic potential of rapid growing mycobacteria in medical or non-medical skin penetrating procedures, their world-wide distribution and demonstrates the dilemmas faced in settings with fewer resources.

View Article: PubMed Central - PubMed

Affiliation: The Hospital for Tropical Diseases, Ho Chi Minh, Vietnam. lannph@oucru.org.

ABSTRACT

Background: Iatrogenic skin and soft tissue infections by rapidly growing mycobacteria are described with increasing frequency, especially among immunocompromised patients.

Case presentation: Here, we present an immunocompetent patient with extensive Mycobacterium fortuitum skin and soft tissue infections after subcutaneous injections to relieve joint pains by a Vietnamese traditional medicine practitioner. Moreover, we present dilemmas faced in less resourceful settings, influencing patient management.

Conclusion: This case illustrates the pathogenic potential of rapid growing mycobacteria in medical or non-medical skin penetrating procedures, their world-wide distribution and demonstrates the dilemmas faced in settings with fewer resources.

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Related in: MedlinePlus

Top, left to right: pretreatment pictures of hands and feet at day 4 and during treatment at day 67, respectively. Bottom, left to right: two pictures of a Ziehl-Neelsen stain (1000X) of aspirated pus from the abscess on dorsal side of the patient’s right hand (acid-fast bacilli indicated with arrowheads), and a blood agar plate of aspirated pus showing non-pigmented dry colonies of Mycobacterium fortuitum after 4 days incubation (with two contaminating yellow colonies in the middle and bottom of the plate).
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Fig1: Top, left to right: pretreatment pictures of hands and feet at day 4 and during treatment at day 67, respectively. Bottom, left to right: two pictures of a Ziehl-Neelsen stain (1000X) of aspirated pus from the abscess on dorsal side of the patient’s right hand (acid-fast bacilli indicated with arrowheads), and a blood agar plate of aspirated pus showing non-pigmented dry colonies of Mycobacterium fortuitum after 4 days incubation (with two contaminating yellow colonies in the middle and bottom of the plate).

Mentions: An immunocompetent, 61-year old female patient from Ho Chi Minh City, Vietnam, was admitted to the Hospital for Tropical Diseases with multiple painful fluctuating and non-fluctuating masses on both hands and feet (see Figure 1) and on her back. She was also subfebrile (37.8°C). Her previous history was uneventful except for mild hypertension and a hysterectomy because of a benign tumour. For the past 2 years she experienced numbness in both hands and feet, which was the reason for consulting a Vietnamese traditional medicine practitioner 15 days prior to admission. For three consecutive days, the patient received an oral preparation, as well as multiple subcutaneous injections (at the metacarpophalangeal and metatarsophalangeal joints of the hands and feet, and at the shoulder and hip joints) with a red substance, both of unknown composition. Five days post-injection, the injection sites became erythematous, painful, and swollen. She developed a fever and was treated at a local clinic with unknown (antimicrobial) drugs without clinical improvement, after which she was admitted to our hospital.Figure 1


Mycobacterium fortuitum skin infections after subcutaneous injections with Vietnamese traditional medicine: a case report.

Lan NP, Kolader ME, Van Dung N, Campbell JI, Tham NT, Chau NV, van Doorn HR, Le DH - BMC Infect. Dis. (2014)

Top, left to right: pretreatment pictures of hands and feet at day 4 and during treatment at day 67, respectively. Bottom, left to right: two pictures of a Ziehl-Neelsen stain (1000X) of aspirated pus from the abscess on dorsal side of the patient’s right hand (acid-fast bacilli indicated with arrowheads), and a blood agar plate of aspirated pus showing non-pigmented dry colonies of Mycobacterium fortuitum after 4 days incubation (with two contaminating yellow colonies in the middle and bottom of the plate).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230753&req=5

Fig1: Top, left to right: pretreatment pictures of hands and feet at day 4 and during treatment at day 67, respectively. Bottom, left to right: two pictures of a Ziehl-Neelsen stain (1000X) of aspirated pus from the abscess on dorsal side of the patient’s right hand (acid-fast bacilli indicated with arrowheads), and a blood agar plate of aspirated pus showing non-pigmented dry colonies of Mycobacterium fortuitum after 4 days incubation (with two contaminating yellow colonies in the middle and bottom of the plate).
Mentions: An immunocompetent, 61-year old female patient from Ho Chi Minh City, Vietnam, was admitted to the Hospital for Tropical Diseases with multiple painful fluctuating and non-fluctuating masses on both hands and feet (see Figure 1) and on her back. She was also subfebrile (37.8°C). Her previous history was uneventful except for mild hypertension and a hysterectomy because of a benign tumour. For the past 2 years she experienced numbness in both hands and feet, which was the reason for consulting a Vietnamese traditional medicine practitioner 15 days prior to admission. For three consecutive days, the patient received an oral preparation, as well as multiple subcutaneous injections (at the metacarpophalangeal and metatarsophalangeal joints of the hands and feet, and at the shoulder and hip joints) with a red substance, both of unknown composition. Five days post-injection, the injection sites became erythematous, painful, and swollen. She developed a fever and was treated at a local clinic with unknown (antimicrobial) drugs without clinical improvement, after which she was admitted to our hospital.Figure 1

Bottom Line: Iatrogenic skin and soft tissue infections by rapidly growing mycobacteria are described with increasing frequency, especially among immunocompromised patients.Moreover, we present dilemmas faced in less resourceful settings, influencing patient management.This case illustrates the pathogenic potential of rapid growing mycobacteria in medical or non-medical skin penetrating procedures, their world-wide distribution and demonstrates the dilemmas faced in settings with fewer resources.

View Article: PubMed Central - PubMed

Affiliation: The Hospital for Tropical Diseases, Ho Chi Minh, Vietnam. lannph@oucru.org.

ABSTRACT

Background: Iatrogenic skin and soft tissue infections by rapidly growing mycobacteria are described with increasing frequency, especially among immunocompromised patients.

Case presentation: Here, we present an immunocompetent patient with extensive Mycobacterium fortuitum skin and soft tissue infections after subcutaneous injections to relieve joint pains by a Vietnamese traditional medicine practitioner. Moreover, we present dilemmas faced in less resourceful settings, influencing patient management.

Conclusion: This case illustrates the pathogenic potential of rapid growing mycobacteria in medical or non-medical skin penetrating procedures, their world-wide distribution and demonstrates the dilemmas faced in settings with fewer resources.

Show MeSH
Related in: MedlinePlus