Primary Cutaneous Mycobacterium kansasii Infection in a Child

Abstract

A 6-year-old girl with a primary cutaneous form of Mycobacterium kansasii infection is presented. Disseminated infection and immune deficiency were excluded in our patient. She was successfully treated with surgical excision and oral erythromycin. Primary cutaneous M. kansasii is an exceedingly rare infection in children.

Nontuberculous Mycobacteria

“…65 Cutaneous lesions can have a sporotrichoid distribution, 66 and present as nonhealing ulcers, nodules, and cellulitis. 67,68 Treatment with a variety of agents, including traditional antituberculous agents as well as erythromycin, minocycline, and doxycycline, has been successful. Because of resistance, antibiotic selection should always be based on specific sensitivities.…”

Mycobacteria other than Mycobacterium tuberculosis are not present in erythema induratum/nodular vasculitis: a case series and literature review of the clinical and histologic findings

“…Cutaneous infection with M. kansasii is rare, mostly occurring as a manifestation of disseminated disease 16 in patients, who are immunocompromised as a result of chemotherapy, autoimmune disease, AIDS and renal or cardiac transplantation. Rare infection in immunocompetent hosts occurs by exogenous inoculation following minimal cutaneous trauma 24,25 . M. kansasii is the most virulent of the MOTT 26 and is characterized by an indolent course and lack of response to antibiotics 27 .…”

“…M. kansasii is the most virulent of the MOTT 26 and is characterized by an indolent course and lack of response to antibiotics 27 . Clinically, the appearance of the lesions varies and includes papules, nodules, pustules, crusted ulcers, chronic verrucous elevated irregular nodules, cellulitis, sporotrichoid lesions, rhinophyma‐like lesions and oral or perianal ulcers 24,28,29 . The histopathology is variable and includes granulomas, abscess, dense polymorphonuclear infiltrate and epidermal necrosis 25 .…”

“…An intense mixed inflammatory infiltrate containing eosinophils may be present in the dermis 30 . The histologic picture may depend on the stage of infection and the immune status of the host with immunocompromised patients, showing neutrophilic inflammation with occasional abscess formation, whereas immunocompetent hosts show a granulomatous infiltrate with or without necrosis 24 . The presence of AFB in tissue sections is also variable 25 …”

Reddish Nodule on the Hand: A Quiz

“…Cutaneous M. kansasii infection has only rarely been described in the literature (4,5). Skin and soft tissue infections usually result from penetrating injuries or disseminated disease, mostly affecting patients with an underlying immunological disorder (1).…”