Research Day
Document Type
Abstract
Date
2017
Abstract
Introduction: Mycobacterial species are unusual causes of skin and soft tissue infections and can be difficult to diagnose in the absence of consideration as they often require specific culture media and longer incubation times. We report a Mycobacterium fortuitum subcutaneous abscess in a diabetic related to medication injection that was initially diagnosed without specialized media or prolonged incubation times. Case Report: A 48 year old diabetic female developed a progressive subcutaneous swelling in the tissues of the right lower abdominal wall where she had been injecting liraglutide. Because of continued enlargement "to almost egg size" with pain, she was empirically treated with cephalexin and trimethoprim/sulfamethoxazole without effect. Subsequently, a formal I&D was performed producing non-foul smelling purulence. The Gram stain showed many WBCs without any organisms seen and the culture revealed a Gram positive rod subsequently identified as M. fortuitum by the Michigan Department of Health and Human Services. She was referred to out-patient Infectious Diseases clinic. when seen, neither before or after drainage had she complained of any fever, chills sweats, unintentional weight loss or other constitutional symptoms. On examination, there was a 2 mm opening without drainage at the inferior-lateral aspect of the otherwise healed I&D incision. The patient was prescribed oral SXT and clarithromycin to be continued for 6 months. On therapy, the incision completely healed and two months following the end of the therapy, she was totally asymptomatic. Conclusion: M. fortuitum is one of the species of mycobacteria that grows rapidly upon culture and can be found during the time that a routine bacterial culture is incubated growing on standard culture media. These organisms are more often identified when the clinician suspects a more unusual etiology of infection because of poor response to standard antimicrobial therapy. In this case, the microbiology laboratory was able to isolate the pathogen without requiring specialized media leading to more rapid and curative therapy.