Subcutaneous infection caused by Mycobacterium abscessus following cosmetic injections of botulinum toxin: A case report

Abstract

BACKGROUND In recent years, the cosmetic intervention related infections caused by nontuberculous mycobacteria (NTM) are increasing as the informal cosmetic treatments are performed. However, many dermatologists are inexperienced in the diagnosis and management of similar cases. Here we report a case of subcutaneous infection caused by Mycobacterium abscessus ( M. abscessus ) following cosmetic injections of botulinum toxin. CASE SUMMARY A 53-year-old woman presented with multiple abscesses and nodules on her forehead and both temporal sites for half a month after cosmetic injections of botulinum toxin. Her lesions did not show any alleviation after 2-wk prescription of antibiotics. Laboratory examinations indicated that she had no sign of immunodeficiency and the whole body of computed tomography did not find any systemic infection or diseases. The pathology of skin tissue showed inflammatory cell infiltration with the negative results of Periodic acid Schiff (PAS) and Acid-fast staining and the culture yielded no microbiome. Afterwards, the puncture on abscess was performed and M. abscessus was successfully isolated. The pathogen was identified by acid-fast staining and DNA sequencing. The patient was treated with the strategy of clarithromycin, ofloxacin, and amikacin according to the result of drug sensitivity test and got complete remission of the lesions. CONCLUSION The case presents the whole process of diagnosis and management of NTM infection after cosmetic intervention and highlights the diagnostic thoughts. In a word, the mycobacterium infection should be aware in patients after cosmetic performance.

Subcutaneous infection caused by Mycobacterium abscessus following botulinum toxin injections: A case report and literature review

“…A total of 24 cases across 18 studies of cutaneous NTM infection after cosmetic injections reported from 2013 to 2023 were identified in the search 4–21 …”

“…A total of 24 cases across 18 studies of cutaneous NTM infection after cosmetic injections reported from 2013 to 2023 were identified in the search. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] The characteristics of the included studies are summarized in Table 1. The majority of the patients were female (23 out of 24 patients), with ages ranging from 28 to 56 years old.…”

“…One of the most common causes of infection is a failure to follow aseptic procedures during invasive procedures, such as non-standard aseptic injection, equipment contamination, or intraoperative infection. 6 This is the primary suspect factor in most cases, which also reminds operators to adhere the idea of sterility in all aspects when performing cosmetic injection, from skin disinfection preparation to thorough sterilization of used equipment. Another possible source of NTM infection is the use of tap water.…”