array:24 [
  "pii" => "S0365059620300672"
  "issn" => "03650596"
  "doi" => "10.1016/j.abd.2019.06.012"
  "estado" => "S300"
  "fechaPublicacion" => "2020-05-01"
  "aid" => "156"
  "copyright" => "Sociedade Brasileira de Dermatologia"
  "copyrightAnyo" => "2020"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by/4.0/"
  "subdocumento" => "sco"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "pt" => array:19 [
      "pii" => "S2666275220301375"
      "issn" => "26662752"
      "doi" => "10.1016/j.abdp.2019.06.012"
      "estado" => "S300"
      "fechaPublicacion" => "2020-05-01"
      "aid" => "156"
      "copyright" => "Sociedade Brasileira de Dermatologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by/4.0/"
      "subdocumento" => "sco"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "pt" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta &#8211; Caso cl&#237;nico</span>"
        "titulo" => "Micobacteriose at&#237;pica cut&#226;nea por <span class="elsevierStyleItalic">M&#46; fortuitum</span> adquirida em ambiente domiciliar"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "390"
            "paginaFinal" => "391"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 783
                "Ancho" => 905
                "Tamanyo" => 69981
              ]
            ]
            "descripcion" => array:1 [
              "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Edema e eritema no quarto quirod&#225;ctilo direito&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Dimitri Luz Felipe da Silva, Let&#237;cia dos Santos Valandro, Paulo Eduardo Neves Ferreira Velho, Andr&#233;a Fernandes Eloy da Costa Fran&#231;a"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Dimitri Luz Felipe da"
                "apellidos" => "Silva"
              ]
              1 => array:2 [
                "nombre" => "Let&#237;cia dos Santos"
                "apellidos" => "Valandro"
              ]
              2 => array:2 [
                "nombre" => "Paulo Eduardo Neves Ferreira"
                "apellidos" => "Velho"
              ]
              3 => array:2 [
                "nombre" => "Andr&#233;a Fernandes Eloy da Costa"
                "apellidos" => "Fran&#231;a"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0365059620300672"
          "doi" => "10.1016/j.abd.2019.06.012"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300672?idApp=UINPBA00008Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220301375?idApp=UINPBA00008Z"
      "url" => "/26662752/0000009500000003/v1_202006250813/S2666275220301375/v1_202006250813/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0365059620300805"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2019.06.015"
    "estado" => "S300"
    "fechaPublicacion" => "2020-05-01"
    "aid" => "169"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by/4.0/"
    "subdocumento" => "sco"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>"
      "titulo" => "The string of pearls pattern in dermoscopy of a chest papule"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "392"
          "paginaFinal" => "393"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 595
              "Ancho" => 750
              "Tamanyo" => 146367
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathology showing a sharply demarcated psoriasiform epidermal hyperplasia composed of clear keratinocytes and basal cells with pale-staining cytoplasm&#44; dilated blood vessels in the dermal papillae as well as perivascular mixed inflammatory infiltration &#40;Hematoxylin &#38; eosin&#44; &#215;40&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Li-Wen Zhang, Wen-Ju Wang, Cong-Hui Li, Tao Chen"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Li-Wen"
              "apellidos" => "Zhang"
            ]
            1 => array:2 [
              "nombre" => "Wen-Ju"
              "apellidos" => "Wang"
            ]
            2 => array:2 [
              "nombre" => "Cong-Hui"
              "apellidos" => "Li"
            ]
            3 => array:2 [
              "nombre" => "Tao"
              "apellidos" => "Chen"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275220301508"
        "doi" => "10.1016/j.abdp.2019.06.015"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220301508?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300805?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009500000003/v4_202007210853/S0365059620300805/v4_202007210853/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0365059620300684"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2019.07.008"
    "estado" => "S300"
    "fechaPublicacion" => "2020-05-01"
    "aid" => "157"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by/4.0/"
    "subdocumento" => "crp"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">What is your diagnosis&#63;</span>"
      "titulo" => "What is your diagnosis&#63; Keloidal cord-like lesion on the leg"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "386"
          "paginaFinal" => "389"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1050
              "Ancho" => 2167
              "Tamanyo" => 315704
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Round structures were seen in reticular dermis &#40;Hematoxylin &#38; eosin&#44; &#215;200&#41;&#46; &#40;B&#41; Grocott&#39;s methenamine silver stain revealed numerous round yeasts arranged containing thick double walls&#44; occurring singly or in chains connected by tubular projections &#40;Groccott&#44; &#215;400&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Flaviano da Silva Oliveira, Nadya Pican&#231;o Lopes, Carolina Talhari, Antonio Schettini"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Flaviano da Silva"
              "apellidos" => "Oliveira"
            ]
            1 => array:2 [
              "nombre" => "Nadya Pican&#231;o"
              "apellidos" => "Lopes"
            ]
            2 => array:2 [
              "nombre" => "Carolina"
              "apellidos" => "Talhari"
            ]
            3 => array:2 [
              "nombre" => "Antonio"
              "apellidos" => "Schettini"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275220301387"
        "doi" => "10.1016/j.abdp.2019.07.008"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220301387?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300684?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009500000003/v4_202007210853/S0365059620300684/v4_202007210853/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>"
    "titulo" => "Atypical cutaneous mycobacteriosis caused by <span class="elsevierStyleItalic">M&#46; fortuitum</span> acquired in domestic environment"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "390"
        "paginaFinal" => "391"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Dimitri Luz Felipe da Silva, Let&#237;cia dos Santos Valandro, Paulo Eduardo Neves Ferreira Velho, Andr&#233;a Fernandes Eloy da Costa Fran&#231;a"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Dimitri Luz Felipe da"
            "apellidos" => "Silva"
            "email" => array:1 [
              0 => "dimitriluzfs@gmail.com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Let&#237;cia dos Santos"
            "apellidos" => "Valandro"
          ]
          2 => array:2 [
            "nombre" => "Paulo Eduardo Neves Ferreira"
            "apellidos" => "Velho"
          ]
          3 => array:2 [
            "nombre" => "Andr&#233;a Fernandes Eloy da Costa"
            "apellidos" => "Fran&#231;a"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Department of Medical Clinic&#44; Faculdade de Ci&#234;ncias M&#233;dicas&#44; Universidade Estadual de Campinas&#44; Campinas&#44; SP&#44; Brazil"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 679
            "Ancho" => 905
            "Tamanyo" => 207497
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Chronic and organized inflammatory process&#44; without detection of acid-fast bacilli and fungi &#40;Hematoxylin &#38; eosin&#44; &#215;40&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A previously healthy caucasian woman&#44; 54 years old&#44; came to dermatology outpatient clinic with an erythematous nodulocystic lesion&#44; about 2<span class="elsevierStyleHsp" style=""></span>cm&#44; with no drainage ostium&#44; located on the dorsal surface of the 4th finger&#59; associated with pain&#44; edema and warmth &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The injury arised four days after local trauma while cleaning her home bathroom&#46; She denied fever&#44; or systemic symptom&#46; There was no improvement despite the use of oral antibiotics and corticosteroids&#46; The hypothesis of pheohyphomycosis&#44; sporotrichosis and atypical mycobacteriosis were considered&#46; Biopsy of the lesion and culture of the liquid content were performed&#46; The anatomopathological analysis showed an organized chronic inflammatory process&#44; occupying the entire thickness of the dermis&#44; but without the presence of fungi and acid-fast bacilli &#8211; AFB &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; <span class="elsevierStyleItalic">Mycobacterium fortuitum</span> was isolated from sample culture on Middlebrook 7H12&#46; Serologies for HIV&#44; hepatitis B and C&#44; and syphilis were all negative&#46; After confirmation of the etiologic agent&#44; treatment with clarithromycin &#40;1<span class="elsevierStyleHsp" style=""></span>g&#47;day&#41; and levofloxacin &#40;1<span class="elsevierStyleHsp" style=""></span>g&#47;day&#41; was implemented&#44; with posterior change of this last medication to sulfamethoxazole-trimethoprim &#40;1200<span class="elsevierStyleHsp" style=""></span>mg&#47;240<span class="elsevierStyleHsp" style=""></span>mg every 12<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; due to gastrointestinal intolerance&#44; leading to complete regression of lesion after 6 months &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Atypical mycobacteria&#44; also known as MOTT &#40;mycobacteria other than tuberculosis&#41;&#44; are acid-fast bacilli with slow growth in culture and very peculiar behavior&#46; MOTT may be saprophytic or found in animals&#44; water and moist places&#46; Atypical mycobacterioses correspond to 10&#37; of mycobacterial infections and preferentially affect immunocompromised individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> The rapidly growing mycobacteria &#40;RGM&#41;&#44; known by their one-week culture growth&#44; can be found in various sites&#46; The most relevant species are&#58; <span class="elsevierStyleItalic">M&#46; fortuitum</span>&#44; <span class="elsevierStyleItalic">M&#46; chelonae</span>&#44; and <span class="elsevierStyleItalic">M&#46; abscessus&#46; M&#46; fortuitum</span> is related with hospital infections in immunocompromised patients&#44; leading to pulmonary&#44; soft tissue and bone infections&#46; Cutaneous involvement is more related to postoperative situations and invasive cosmetic procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The present case corresponds to cutaneous infection by <span class="elsevierStyleItalic">M&#46; fortuitum</span> in an immunocompetent patient&#44; acquired at home&#44; probably by a trauma in an humid area&#46; Differential diagnosis is made with swimming-pool granuloma&#44; caused by <span class="elsevierStyleItalic">M&#46; marinum</span>&#44; due to the circumstances in which the infection was acquired&#44; but culture allowed to the definitive etiology&#46; The diagnosis of atypical mycobacterioses is made through the isolation of the agent in culture&#44; since radiological&#44; histopathological and clinical examinations are often inconclusive&#46; The history of long-standing infection&#44; without improvement after different treatments&#44; can lead to clinical suspicion&#46; The follow-up includes long-term broad-spectrum antibiotic treatment&#46; The macrolide group in combination with quinolones is one of the most recommended regimens&#44; sometimes requiring surgical intervention&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3&#44;4</span></a> The present report reinforces the importance in considering atypical mycobacterioses among the differential diagnoses of traumatic cutaneous lesions&#44; especially when they tend to chronicity&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors&#8217; contributions</span><p id="par0015" class="elsevierStylePara elsevierViewall">Dimitri Luz Felipe da Silva&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analysis&#44; and interpretation of the data&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Let&#237;cia dos Santos Valandro&#58; Conception and planning of the study&#59; critical review of the literature&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Paulo Eduardo Neves Ferreira Velho&#58; Intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Andr&#233;a Fernandes Eloy da Costa Fran&#231;a&#58; Approval of the final version of the manuscript&#59; elaboration and writing of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:4 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Authors&#8217; contributions"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Financial support"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conflicts of interest"
        ]
        3 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-01-22"
    "fechaAceptado" => "2019-06-14"
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article&#58; Silva DLF&#44; Valandro LS&#44; Velho PENF&#44; Fran&#231;a AFEC&#46; Atypical cutaneous mycobacteriosis caused by <span class="elsevierStyleItalic">M&#46; fortuitum</span> acquired in domestic environment&#46; An Bras Dermatol&#46; 2020&#59;95&#58;387&#8211;8&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital de Cl&#237;nicas&#44; Universidade Estadual de Campinas&#44; Campinas&#44; SP&#44; Brazil&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 783
            "Ancho" => 905
            "Tamanyo" => 69981
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Right hand&#58; edema and erythema on the fourth finger&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 679
            "Ancho" => 905
            "Tamanyo" => 207497
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Chronic and organized inflammatory process&#44; without detection of acid-fast bacilli and fungi &#40;Hematoxylin &#38; eosin&#44; &#215;40&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1497
            "Ancho" => 905
            "Tamanyo" => 116559
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Regression of inflammation after antibiotic treatment&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:4 [
            0 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tratado de dermatologia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;R&#46;W&#46; Belda"
                            1 => "N&#46; Chiachio"
                            2 => "J&#46;R&#46;P&#46; Criado"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "2nd ed&#46;"
                        "fecha" => "2015"
                        "editorial" => "Ed Atheneu"
                        "editorialLocalizacion" => "Rio de Janeiro"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical significance of <span class="elsevierStyleItalic">Mycobacterium fortuitum</span> isolated from respiratory specimens"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Park"
                            1 => "G&#46;Y&#46; Suh"
                            2 => "M&#46;P&#46; Chung"
                            3 => "H&#46; Kim"
                            4 => "O&#46;J&#46; Kwon"
                            5 => "K&#46;S&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2008"
                        "volumen" => "102"
                        "paginaInicial" => "437"
                        "paginaFinal" => "442"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atypical cutaneous mycobacteriosis following mesotherapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;C&#46;G&#46;O&#46; Sousa"
                            1 => "C&#46;P&#46; Pereira"
                            2 => "N&#46;S&#46; Guimaraes"
                            3 => "V&#46;R&#46; Rego"
                            4 => "A&#46;P&#46; Paix&#227;o"
                            5 => "J&#46;R&#46;A&#46;A&#46; Barbosa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2001"
                        "volumen" => "76"
                        "paginaInicial" => "711"
                        "paginaFinal" => "715"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disseminated cutaneous atypical mycobacteriosis by <span class="elsevierStyleItalic">M&#46; chelonae</span> after sclerotherapy of varicose veins in a immunocompetent patient&#58; a case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46;D&#46; Murback"
                            1 => "M&#46;G&#46; Higa J&#250;nior"
                            2 => "M&#46;A&#46; Pomp&#237;lio"
                            3 => "E&#46;S&#46; Cury"
                            4 => "G&#46; Hans Filho"
                            5 => "L&#46;C&#46; Takita"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/abd1806-4841.20153445"
                      "Revista" => array:7 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2015"
                        "volumen" => "90"
                        "numero" => "S1"
                        "paginaInicial" => "36"
                        "paginaFinal" => "39"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26312669"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/03650596/0000009500000003/v4_202007210853/S0365059620300672/v4_202007210853/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "82769"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case Letter"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009500000003/v4_202007210853/S0365059620300672/v4_202007210853/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300672?idApp=UINPBA00008Z"
]
Share
Journal Information
Vol. 95. Issue 3.
Pages 390-391 (1 May 2020)
Visits
5755
Vol. 95. Issue 3.
Pages 390-391 (1 May 2020)
Case Letter
Open Access
Atypical cutaneous mycobacteriosis caused by M. fortuitum acquired in domestic environment
Visits
5755
Dimitri Luz Felipe da Silva
Corresponding author
dimitriluzfs@gmail.com

Corresponding author.
, Letícia dos Santos Valandro, Paulo Eduardo Neves Ferreira Velho, Andréa Fernandes Eloy da Costa França
Department of Medical Clinic, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
This item has received

Under a Creative Commons license
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (3)
Show moreShow less
Full Text
Dear Editor,

A previously healthy caucasian woman, 54 years old, came to dermatology outpatient clinic with an erythematous nodulocystic lesion, about 2cm, with no drainage ostium, located on the dorsal surface of the 4th finger; associated with pain, edema and warmth (Fig. 1). The injury arised four days after local trauma while cleaning her home bathroom. She denied fever, or systemic symptom. There was no improvement despite the use of oral antibiotics and corticosteroids. The hypothesis of pheohyphomycosis, sporotrichosis and atypical mycobacteriosis were considered. Biopsy of the lesion and culture of the liquid content were performed. The anatomopathological analysis showed an organized chronic inflammatory process, occupying the entire thickness of the dermis, but without the presence of fungi and acid-fast bacilli – AFB (Fig. 2). Mycobacterium fortuitum was isolated from sample culture on Middlebrook 7H12. Serologies for HIV, hepatitis B and C, and syphilis were all negative. After confirmation of the etiologic agent, treatment with clarithromycin (1g/day) and levofloxacin (1g/day) was implemented, with posterior change of this last medication to sulfamethoxazole-trimethoprim (1200mg/240mg every 12h), due to gastrointestinal intolerance, leading to complete regression of lesion after 6 months (Fig. 3).

Figure 1.

Right hand: edema and erythema on the fourth finger.

(0.07MB).
Figure 2.

Chronic and organized inflammatory process, without detection of acid-fast bacilli and fungi (Hematoxylin & eosin, ×40).

(0.2MB).
Figure 3.

Regression of inflammation after antibiotic treatment.

(0.11MB).

Atypical mycobacteria, also known as MOTT (mycobacteria other than tuberculosis), are acid-fast bacilli with slow growth in culture and very peculiar behavior. MOTT may be saprophytic or found in animals, water and moist places. Atypical mycobacterioses correspond to 10% of mycobacterial infections and preferentially affect immunocompromised individuals.1 The rapidly growing mycobacteria (RGM), known by their one-week culture growth, can be found in various sites. The most relevant species are: M. fortuitum, M. chelonae, and M. abscessus. M. fortuitum is related with hospital infections in immunocompromised patients, leading to pulmonary, soft tissue and bone infections. Cutaneous involvement is more related to postoperative situations and invasive cosmetic procedures.2 The present case corresponds to cutaneous infection by M. fortuitum in an immunocompetent patient, acquired at home, probably by a trauma in an humid area. Differential diagnosis is made with swimming-pool granuloma, caused by M. marinum, due to the circumstances in which the infection was acquired, but culture allowed to the definitive etiology. The diagnosis of atypical mycobacterioses is made through the isolation of the agent in culture, since radiological, histopathological and clinical examinations are often inconclusive. The history of long-standing infection, without improvement after different treatments, can lead to clinical suspicion. The follow-up includes long-term broad-spectrum antibiotic treatment. The macrolide group in combination with quinolones is one of the most recommended regimens, sometimes requiring surgical intervention.3,4 The present report reinforces the importance in considering atypical mycobacterioses among the differential diagnoses of traumatic cutaneous lesions, especially when they tend to chronicity.

Authors’ contributions

Dimitri Luz Felipe da Silva: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; critical review of the literature; critical review of the manuscript.

Letícia dos Santos Valandro: Conception and planning of the study; critical review of the literature.

Paulo Eduardo Neves Ferreira Velho: Intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases.

Andréa Fernandes Eloy da Costa França: Approval of the final version of the manuscript; elaboration and writing of the manuscript; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases.

Financial support

None declared.

Conflicts of interest

None declared.

References
[1]
J.R.W. Belda, N. Chiachio, J.R.P. Criado.
Tratado de dermatologia.
2nd ed., Ed Atheneu, (2015),
[2]
S. Park, G.Y. Suh, M.P. Chung, H. Kim, O.J. Kwon, K.S. Lee, et al.
Clinical significance of Mycobacterium fortuitum isolated from respiratory specimens.
Respir Med, 102 (2008), pp. 437-442
[3]
A.C.G.O. Sousa, C.P. Pereira, N.S. Guimaraes, V.R. Rego, A.P. Paixão, J.R.A.A. Barbosa.
Atypical cutaneous mycobacteriosis following mesotherapy.
An Bras Dermatol, 76 (2001), pp. 711-715
[4]
N.D. Murback, M.G. Higa Júnior, M.A. Pompílio, E.S. Cury, G. Hans Filho, L.C. Takita.
Disseminated cutaneous atypical mycobacteriosis by M. chelonae after sclerotherapy of varicose veins in a immunocompetent patient: a case report.
An Bras Dermatol, 90 (2015), pp. 36-39

How to cite this article: Silva DLF, Valandro LS, Velho PENF, França AFEC. Atypical cutaneous mycobacteriosis caused by M. fortuitum acquired in domestic environment. An Bras Dermatol. 2020;95:387–8.

Study conducted at the Hospital de Clínicas, Universidade Estadual de Campinas, Campinas, SP, Brazil.

Copyright © 2020. Sociedade Brasileira de Dermatologia
Download PDF
Idiomas
Anais Brasileiros de Dermatologia
Article options
Tools
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.