Swimming Pool Granuloma

Philpott, James A.

doi:10.1001/archderm.1963.01590200046008

Cited by 110 publications

(22 citation statements)

References 7 publications

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“…Typical histologic changes are numerous well-formed infectious granulomas 17. In less than 50% of cases, acid-fast organisms are detectable in the biopsy sections 5,14.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of refractory cutaneous infection caused by Mycobacterium marinum with a combined regimen containing amikacin

Huang¹,

Xu²,

Yi³

et al. 2012

CIA

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Background:The incidence of Mycobacterium marinum infection has been increasing. First-line antituberculous drugs and other common antibiotics are effective for most cutaneous M. marinum infections; however, treatment failure still occurs in some rare cases. We report a case of a 70-year-old man with refractory cutaneous infection caused by M. marinum. Reasons for delayed diagnosis and related factors of the refractory infection are also discussed.Methods:Samples of lesional skin were inoculated on Löwenstein–Jensen medium for acid-fast bacilli. Species of mycobacterium were identified by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) analysis. We then carried out genotyping by using mycobacterial interspersed repetitive units and sequencing of heat shock protein 65 (hsp65) and 16S rDNA genes.Results:Tissue cultures for acid-fast bacilli were positive. PCR-RFLP analysis and sequencing of hsp65 and 16S rDNA genes confirmed the isolated organisms to be M. marinum. Systemic therapy with rifampicin, clarithromycin, and amikacin empirically over 6 months led to complete resolution of skin lesions leaving only some residual scars.Conclusion:Key diagnostic elements for M. marinum infections include a high index of suspicion raised by chronic lesions, poor response to conventional treatments, and a history of fish-related exposure. Strong clinical suggestion of M. marinum infection warrants initial empirical treatment. The duration of therapy is usually several months or even longer, especially for elderly patients. Amikacin can be considered in multidrug therapy for treatment of some refractory M. marinum infections.

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“…Typical histologic changes are numerous well-formed infectious granulomas 17. In less than 50% of cases, acid-fast organisms are detectable in the biopsy sections 5,14.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of refractory cutaneous infection caused by Mycobacterium marinum with a combined regimen containing amikacin

Huang¹,

Xu²,

Yi³

et al. 2012

CIA

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“…It is essential to remove all the infected synovium in order to prevent recurrences and this often requires repeated debridements. 2 The tissue should be sent for histology and specialized medium to culture this atypical bacterium.…”

Section: Discussionmentioning

confidence: 99%

Mycobacterium marinum as a cause of chronic granulomatous tenosynovitis in the hand

Pang

Lee

Puhaindran

et al. 2007

Journal of Infection

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“…A chronic granulomatous skin lesion presents either as single or multiple nodules, usually on the hand or foot. Spontaneous resolution can take months or years [1,4].…”

Section: Discussionmentioning

confidence: 99%

“…MYCOBACTERIUM marinum is an atypical mycobacterium usually associated with cutaneous lesions [1]. Deeper infection can cause tenosynovitis [2] and septic arthritis [3], typically a monoarthritis of the upper limb in otherwise healthy individuals [4].…”

mentioning

confidence: 99%

Mycobacterium marinum infection causing septic arthritis and osteomyelitis

Barton¹,

Bernstein²,

Struthers³

et al. 1997

Rheumatology

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SUMMARYA 48-yr-old female on immunosuppressive therapy for ®brosing alveolitis and polymyositis developed a septic arthritis of the left middle ®nger proximal interphalangeal joint, tenosynovitis of the left palm and osteomyelitis of the right hindfoot due to infection with Mycobacterium marinum. Such widespread and severe bone and joint involvement has not been described previously with this organism. CASE REPORTIn March 1994, a 48-yr-old woman presented with erythema and full-thickness ulceration over the left middle ®nger proximal interphalangeal joint (PIPJ) and a red nodule on the¯exor aspect of the right forearm. Biopsy of the nodule showed a pallisaded granuloma consistent with a rheumatoid nodule. She was known to have the Jo-1 syndrome with mild polymyositis, biopsy-proven severe ®bros-ing alveolitis and the presence of the Jo-1 antibody. Immunosuppressive treatment with oral cyclophosphamide (150 mg/day) and prednisolone had been commenced in September 1993. Following a deterioration in lung function, the dose of prednisolone was increased to 60 mg/day in December 1994. One month later, she presented with a 2 week history of pain and swelling about the right ankle and midfoot, and a swelling in the left palm.On examination in January 1995, she was cushingoid. There was purple macular discolouration over the metacarpophalangeal joints (MCPJ) of both hands. The PIPJ of the left middle ®nger was swollen, red and tender (Fig. 1). The left palm was swollen. There was a nodular erythematous rash over the¯exor aspect of the right forearm near the elbow. The right ankle and midfoot were swollen and painful to move.Investigations revealed a white cell count of 12.6 Â 10 9 /l (compared with a previous count of 9.3 Â 10 9 /l) with 11.4 Â 10 9 /l neutrophils, 0.5 Â 10 9 /l lymphocytes and an erythrocyte sedimentation rate of 50 mm in the ®rst hour. Radiographs of the left hand revealed joint space narrowing at the third PIPJ. X-ray of the right foot showed narrowing of the joint space between the navicular and medial cuneiform bones. Green turbid¯uid was aspirated from the right midfoot and bloodstained¯uid from the PIPJ of the left middle ®n-ger. Culture of the¯uid was sterile. The right ankle was injected with intra-articular steroids with temporary relief. Further aspiration gave frank pus containing acid-fast bacilli (AFB), eventually identi®ed as Mycobacterium marinum. The tendon sheaths of the left palm were incised and drained surgically. Mycobacterium marinum was again isolated.The patient kept tropical ®sh and cleaned the tank twice a year.Standard anti-tuberculous chemotherapy (rifampicin, isoniazid and pyrazinamide) caused intolerable nausea. Doxycycline, 100 mg b.d., was prescribed instead.Radiographs of the left hand 6 weeks later showed an erosion of the PIPJ of the middle ®nger. Computed tomography of the right foot showed joint space narrowing and erosions involving the navicular, cuboid and all three cuneiform bones consistent with septic arthritis and osteomyelitis of the entire midfoot (Fig. 2)...

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Swimming Pool Granuloma

Cited by 110 publications

References 7 publications

Successful treatment of refractory cutaneous infection caused by Mycobacterium marinum with a combined regimen containing amikacin

Successful treatment of refractory cutaneous infection caused by Mycobacterium marinum with a combined regimen containing amikacin

Mycobacterium marinum as a cause of chronic granulomatous tenosynovitis in the hand

Mycobacterium marinum infection causing septic arthritis and osteomyelitis

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