Atypical Mycobacterial Infections Following Cutaneous Surgery

Postoperative Mycobacterium chelonae Infection Mimicking A Granulomatous Suture Reaction

“…Cutaneous M. chelonae infections are seen in immunocompromised patients, particularly those with defects in the IL-12/IFN-g axis and GATA2 deficiencies or in immunocompetent patients after surgical procedures or traumatic innoculation. [1][2][3][4] Mycobacterium chelonae infections have been described after multiple dermatologic surgical and cosmetic procedures, including Mohs micrographic surgery, laser resurfacing, botulinum toxin injections, hair transplant, liposuction, tattooing, body piercing, and acupuncture. 2,4 Key distinguishing features suggestive of cutaneous atypical mycobacterium in a postoperative patient include nodules that are tender, are located on the distal extremities, and have an erythematous-to-purple color.…”

“…[1][2][3][4] Mycobacterium chelonae infections have been described after multiple dermatologic surgical and cosmetic procedures, including Mohs micrographic surgery, laser resurfacing, botulinum toxin injections, hair transplant, liposuction, tattooing, body piercing, and acupuncture. 2,4 Key distinguishing features suggestive of cutaneous atypical mycobacterium in a postoperative patient include nodules that are tender, are located on the distal extremities, and have an erythematous-to-purple color. 1,3 Histopathology can further distinguish between atypical mycobacteria, granulomatous suture reaction, and malignancy recurrence.…”

“…Notably, the standard Acid-fast bacteria staining may be negative, so tissue culture is the gold standard for the diagnosis of M. chelonae . 4 Treatment of M. chelonae is typically with clarithromycin for a minimum of 4 to 6 months; severe infections may require dual antibiotic therapy. Localized lesions can be surgically excised in addition to treating with oral therapy.…”

Use of a Cotton-Tipped Applicator to Measure the Extent of Undermining

“…Localized lesions can be surgically excised in addition to treating with oral therapy. 3,4 Recognizing atypical mycobacterial infections is important for determining management. Atypical mycobacteria are resistant to many antibiotics-if treated as a standard postoperative wound infection, the antibiotics likely will not cover the atypical mycobacteria and the treatment course will be too short.…”