CutaneousMycobacterium massilienseinfection associated with cupping therapy

Abstract

Nontuberculous mycobacteria (NTM) are ubiquitous organisms that are now seen as emerging human pathogens. NTM infections are very difficult to diagnose and treat, therefore a high index of clinical suspicion is needed for diagnosis. Cutaneous NTM infections have been primarily reported associated with previous invasive procedures. We report the case of a healthy 59-year-old woman who developed recurring abdominal skin lesions caused by Mycobacterium massiliense after she underwent noninvasive cupping therapy. We identified the pathogen using a PCR assay targeting the erm(41) gene of the bacterium. The patient was treated successfully by en bloc excision and long-term antibiotic treatment. This case shows that cutaneous infection with M. massiliense may occur in an immunocompetent person without an antecedent invasive procedure.

Lésions cutanées secondaires à la médecine des ventouses ( hijama )

“…La hijama est un facteur de risque de transmission de l'hépatite C [4], de l'hépatite B [5], de l'HTLV-I [6] et probablement du VIH [4]. De plus, des infections locorégionales (mycobactéries environnementales [7], abcès épiduraux cervicaux ou lombaires [8,9]) ont été rapportées. Par ailleurs, hormis les ecchymoses transitoires en rapport avec le procédé lui-même, des bulles hémorragiques, des chéloïdes [10], une panniculite [11] ou un phénomène de Koebner lors de leurs applications pour le traitement de dermatoses chroniques sont signalés [12].…”

Case of abscess caused by Mycobacterium massiliense associated with swimming

“…1 This species could cause not only disseminated infections in immunocompromised patients but also cutaneous infection in healthy patients usually associated with trauma and injection that have occurred in hospitals. 2 However, cutaneous M. massiliense infections without antecedent event have been reported rarely; a hot spa in Japan, 3 public bath in Korea, 4 disseminated lesion on both shins, pedicure footbaths and cupping therapy have been supposed as infection reservoirs. 3 Herein, we report the case of a woman with abscess caused by M. massiliense that occurred after swimming.…”

“…2 However, cutaneous M. massiliense infections without antecedent event have been reported rarely; a hot spa in Japan, 3 public bath in Korea, 4 disseminated lesion on both shins, pedicure footbaths and cupping therapy have been supposed as infection reservoirs. 3 Herein, we report the case of a woman with abscess caused by M. massiliense that occurred after swimming.…”

“…Among these, just three cases were not preceded by a previous event. 3 This infection is usually assumed to have originated from an environmental source but it may occur in immunocompetent patients without antecedent event. It is usually difficult to diagnose non-tuberculous mycobacterium (NTM) because of its various clinical manifestations and lower sensitivity of culture results.…”

“…5 Previously, combination therapy including clarithromycin with other antibiotics has been used empirically for the treatment against M. massiliense. [1][2][3] At present, we treat our patient with clarithromycin alone and with good improvement. Long-term medication is recommended to prevent recurrence.…”