Tropical/Infectoparasitary Dermatology
Cutaneous infection by Mycobacterium lentiflavum after subcutaneous injection of lipolytic formula
Renan Bernardes de Melloa,
, Dalton Nogueira Moreirab, Ana Carolina Gomes Pereirac, Nicole Ramalho Lustosad
Corresponding author
a Postgraduate Program in Health Sciences, Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
b Orestes Diniz Training and Reference Center for Infectious and Parasitic Diseases, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
c Department of Clinical Medicine, Hospital Semper, Belo Horizonte, MG, Brazil
d Dermatology Service, Hospital da Polícia Militar de Belo Horizonte, Belo Horizonte, MG, Brazil
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(B) Disseminated atrophic scars at the end of an 8-month course of treatment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atypical mycobacterioses are caused by heterogeneous species of mycobacteria that can be classified through various criteria, such as slow-growing nontuberculous mycobacteria and fast-growing mycobacteria, pigment production, colony morphology, and other biochemical tests.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> In addition to nontuberculous mycobacteria (NTM), the obligate pathogens of the <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> complex and <span class="elsevierStyleItalic">Mycobacterium leprae</span> also belong to the genus <span class="elsevierStyleItalic">Mycobacterium</span>, causing tuberculosis and leprosy, respectively.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> With the application of molecular biology techniques, among them high-performance liquid chromatography (HPLC) of mycolic acids, polymerase chain reaction (PCR), restriction enzyme, and genetic sequencing, new species of NTM have been described, broadening the understanding of its ecology, microbiology, and significance in medical practice.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In the clinical setting, species recognition is relevant due to intrinsic resistance of NTM to current anti-tuberculosis regimens.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">NTMs are generally free-living saprophytes and have been isolated in water, soil, aerosols, and on objects, including medical utensils and equipment.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> NMT infections have already been reported as complications in the following procedures: cardiac and ophthalmologic surgery, liposculpture/liposuction, mammoplasty, tattooing, application of botulinum toxin and fractionated CO<span class="elsevierStyleInf">2</span> laser, skin filling, mesotherapy, skin biopsy, Mohs surgery, pedicure, acupuncture, piercing implant, and variceal sclerotherapy.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4–6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In this context, fast-growing species are often isolated, such as the <span class="elsevierStyleItalic">M. fortuitum</span>, <span class="elsevierStyleItalic">M. abscessus</span>, and <span class="elsevierStyleItalic">M. chelonae</span>.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> Unlike the fast-growing NTMs, <span class="elsevierStyleItalic">M. lentiflavum</span> is a slow-growing bacteria, which has been associated with superficial lymphadenitis in children and pulmonary infections, mainly in immunosuppressed patients.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7–9</span></a> However, cutaneous mycobacteriosis due to <span class="elsevierStyleItalic">M. lentiflavum</span> is rare and was first reported in an HIV-infected patient with a CD4+ T lymphocyte count of 46/mm<span class="elsevierStyleSup">3</span>, by Montejo et al. in 2006.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The present report details the case of a healthy 28-year-old woman who underwent subcutaneous applications of a substance composed of 5% sunflower oil, 6% deoxycholate, 5% sinetrol, and caffeine 50<span class="elsevierStyleHsp" style=""></span>mg in the abdomen and flanks by a non-medical professional, with weekly intervals between sessions. After the fourth application, she presented pain, erythema, and heat at the infiltration site (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B). There was further worsening of pain and edema, associated with drainage of a purulent secretion (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The direct microscopic examination and culture for fungi and bacteria of the lesion secretion in the abdomen, besides the serologies for viral hepatitis and HIV, were negative. The acid-fast bacilli smear (AFB) was positive in two different samples. The PCR test for <span class="elsevierStyleItalic">M. tuberculosis</span> was negative and the chest X-ray showed no abnormalities. Then, empiric treatment for atypical mycobacteriosis was decided upon, using clarithromycin 500<span class="elsevierStyleHsp" style=""></span>mg twice daily associated with levofloxacin 500<span class="elsevierStyleHsp" style=""></span>mg once daily, as well as debridement of the lesions. The histopathological study revealed chronic granulomatous and suppurative inflammation, with organized abscesses, absence of vasculitis, and negative findings for specific microorganisms (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A and B). The restriction fragmentation length polymorphism (RFLP) analysis of DNA generated by PCR was compatible with <span class="elsevierStyleItalic">Mycobacterium lentiflavum</span>. After two months of treatment, there was partial improvement of the condition (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>A), and at the end of an eight-month course of treatment, complete remission with atrophic scars was observed (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>B).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors' contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">Renan Bernardes de Mello: Approval of final version of the manuscript; conception and planning of the study; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Dalton Nogueira Moreira: Approval of final version of the manuscript; conception and planning of the study; drafting and editing of the manuscript; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Ana Carolina Gomes Pereira: Approval of final version of the manuscript; conception and planning of the study; drafting and editing of the manuscriptcritical review of the manuscript.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Nicole Ramalho Lustosa: Approval of final version of the manuscript; conception and planning of the study; drafting and editing of the manuscriptcritical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:3 [ "identificador" => "xres1370012" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1259084" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-07-13" "fechaAceptado" => "2019-11-09" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1259084" "palabras" => array:3 [ 0 => "Mesotherapy" 1 => "Mycobacterium infections, nontuberculous" 2 => "Soft tissue infections" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The incidence of nontuberculous mycobacterial infections is increasing worldwide; by 2017, more than 190 species and subspecies have been documented. Although classically associated with immunosuppression, the recognition of these etiological agents in diseases affecting immunocompetent individuals and in healthcare-associated infections, such as after surgical and cosmetic procedures, makes the study of the epidemiology and pathogenesis of these microorganisms relevant in medical practice. <span class="elsevierStyleItalic">Mycobacterium lentiflavum</span> is slow-growing and rarely affects the skin. A case of cutaneous mycobacteriosis caused by <span class="elsevierStyleItalic">M. lentiflavum</span> is reported in an immunocompetent patient after subcutaneous injection of a lipolytic compound, treated with clarithromycin and levofloxacin.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Mello RB, Moreira DN, Pereira ACG, Lustosa NR. Cutaneous infection by <span class="elsevierStyleItalic">Mycobacterium lentiflavum</span> after subcutaneous injection of lipolytic formula. An Bras Dermatol. 2020;95:511–3.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 553 "Ancho" => 1674 "Tamanyo" => 86317 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A and B) Erythematous and infiltrated nodules in the abdomen.</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" => 700 "Ancho" => 1674 "Tamanyo" => 152092 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A and B) Erythematous and infiltrated nodules and plaques, some with ulceration and suppuration.</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" => 791 "Ancho" => 1674 "Tamanyo" => 413273 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) Superficial and deep lymphohistiocytic and granulomatous infiltrate, with suppuration and organized abscesses (Hematoxylin & eosin, x200). (B) In detail, acid-fast bacilli are noted in the purulent secretion (Hematoxylin & eosin, x400).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 635 "Ancho" => 1674 "Tamanyo" => 134848 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Decreased inflammatory process after 2 months of antibiotic therapy. 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| Year/Month | Html | Total | |
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