Mycobacterium Fortuitum infection after abdominoplasty and breast reduction: case report, diagnostic tips and tricks, and overview of the current therapeutic consensus

Abstract

Background: Surgical site infections caused by non-tuberculous mycobacteria (NTM) are increasingly reported in the literature. Mycobacterium Fortuitum is the one that is most frequently associated with surgical site infections. Case Presentation: We present our first case of Mycobacterium Fortuitum infection after combined abdominoplasty and bilateral breast reduction. Discussion and Conclusions: Diagnosis of NTM-infections remains difficult. Typical symptoms are minor wound dehiscences with the evacuation of clear, odorless fluid collections. The onset can vary between one week to two years postoperatively. A wound dehiscence of a previously closed wound or slow healing of a wound must encourage a prompt diagnosis. A proper amount of fluid collection and/or tissue biopsy are necessary for an accurate diagnosis. Acid-fast or fluorochrome staining are also preferred over classic Gram staining. Treatment consists of proper surgical debridement and long-term, targeted, antibiotic combination therapy. Surgical debridement involves surgical drainage and removal of any infected foreign material. With regards to the antibiotic treatment, a dual antibiotic therapy, consisting of an oral Macrolide with initial parental therapy of Amikacin, is recommended. However, other combinations have been reported and also seem efficacious. An antibiotic treatment of four to six months is advised. The prognosis is usually favorable, although complete healing can sometimes be annoyingly long.