Iatrogenic Mycobacterium simiae Skin Infection in an Immunocompetent Patient

摘要

To the Editor: We report a case ofa 36-year-old woman who soughttreatment for 45 firm and erythema-tous nodular lesions on her face andneck. A physical examination showedno other abnormalities. Results of achest x-ray and routine laboratorytests were normal. The patient testednegative for hepatitis B and HIV.Three weeks before she sought treat-ment, the patient reported receivingmultiple intradermal microinjectionsin her face and neck for cosmetic pur-poses (mesotherapy) with an unli-censed product consisting of a solu-tion of glycosaminoglycans. Theinjections had been administered byan unlicensed practitioner in a non-medical office setting. The patientstated that 2 days after the therapy, afever developed; it persisted for sev-eral days, along with redness at theinoculation sites, which graduallydeveloped into nodules. Standard staining of a biopsiedspecimen from the lesion site wasnegative for bacteria, fungi, andmycobacteria. A histopathologicexamination of a biopsy specimenshowed an unspecific granulomatousinfiltrate. Culture for common bacte-ria and fungi was negative, but cultureof a sterile nodule aspirate onLowenstein-Jensen medium was posi-tive for acid-fast bacteria after 5weeks. By using restriction endonu-clease analysis of the 65-kDa heatshock protein gene (1), we found thatthe isolate showed a pattern compati-ble with Mycobacterium simiae.Identification was subsequently con-firmed by high performance liquidchromatography of mycolic acids atthe Centers for Disease Control andPrevention, Atlanta, Georgia. The iso-late was tested for drug susceptibilityagainst a panel of drugs and found tobe resistant to most drugs tested(streptomycin, isoniazid, rifampin,ethambutol, ethionamide, rifabutin,ciprofloxacin, kanamycin, capre-omycin, p-aminosalicylic acid,ofloxacin, and amikacin) and suscep-tible to clarithromycin at an MIC of 1μg/mL. Treatment with clar-ithromycin was started, and the gran-ulomas slowly cleared after 9 monthsof treatment