An 82-year-old woman with Mycobacterium avium pulmonary disease, diabetes mellitus and dementia had been taking clarithromycin, ethambutol and rifampicin for 3 years due to persistent positive sputum cultures. Because of the rapid worsening of her dementia, adherence to medications became poor. She had presented diabetic foot ulcer (DFU) in both her feet (Figure 1a). It was unclear how long the DFU had been on her feet. When she came to the hospital, her toes were covered with saliva and had a bad odor and pus. She had continued to self-medicate with saliva on her foot for 2 months. The DFU consisted of numerous mycobacteria (Figure 1b). M. avium was grown with Ogawa egg medium (Figure 1c).
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