Case Letter
Atypical cutaneous mycobacteriosis caused by M. fortuitum acquired in domestic environment
Dimitri Luz Felipe da Silva
, Letícia dos Santos Valandro, Paulo Eduardo Neves Ferreira Velho, Andréa Fernandes Eloy da Costa França
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Department of Medical Clinic, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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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 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). <span class="elsevierStyleItalic">Mycobacterium fortuitum</span> 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 (1<span class="elsevierStyleHsp" style=""></span>g/day) and levofloxacin (1<span class="elsevierStyleHsp" style=""></span>g/day) was implemented, with posterior change of this last medication to sulfamethoxazole-trimethoprim (1200<span class="elsevierStyleHsp" style=""></span>mg/240<span class="elsevierStyleHsp" style=""></span>mg every 12<span class="elsevierStyleHsp" style=""></span>h), due to gastrointestinal intolerance, leading to complete regression of lesion after 6 months (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">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.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> The rapidly growing mycobacteria (RGM), known by their one-week culture growth, can be found in various sites. The most relevant species are: <span class="elsevierStyleItalic">M. fortuitum</span>, <span class="elsevierStyleItalic">M. chelonae</span>, and <span class="elsevierStyleItalic">M. abscessus. M. fortuitum</span> 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.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The present case corresponds to cutaneous infection by <span class="elsevierStyleItalic">M. fortuitum</span> 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 <span class="elsevierStyleItalic">M. marinum</span>, 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.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3,4</span></a> The present report reinforces the importance in considering atypical mycobacterioses among the differential diagnoses of traumatic cutaneous lesions, especially when they tend to chronicity.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors’ contributions</span><p id="par0015" class="elsevierStylePara elsevierViewall">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.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Letícia dos Santos Valandro: Conception and planning of the study; critical review of the literature.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Paulo Eduardo Neves Ferreira Velho: Intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases.</p><p id="par0030" class="elsevierStylePara elsevierViewall">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.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared.</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.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ 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" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Silva DLF, Valandro LS, Velho PENF, França AFEC. Atypical cutaneous mycobacteriosis caused by <span class="elsevierStyleItalic">M. fortuitum</span> acquired in domestic environment. An Bras Dermatol. 2020;95:387–8.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital de Clínicas, Universidade Estadual de Campinas, Campinas, SP, Brazil.</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: edema and erythema on the fourth finger.</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, without detection of acid-fast bacilli and fungi (Hematoxylin & eosin, ×40).</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.</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.R.W. 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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" ]
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| 2024 Fevereiro | 85 | 97 | 182 |
| 2024 Janeiro | 52 | 53 | 105 |
| 2023 Dezembro | 97 | 57 | 154 |
| 2023 Novembro | 83 | 80 | 163 |
| 2023 Outubro | 64 | 73 | 137 |
| 2023 Setembro | 103 | 79 | 182 |
| 2023 Agosto | 87 | 40 | 127 |
| 2023 Julho | 47 | 43 | 90 |
| 2023 Junho | 62 | 42 | 104 |
| 2023 Maio | 40 | 23 | 63 |
| 2023 Abril | 35 | 20 | 55 |
| 2023 Março | 59 | 45 | 104 |
| 2023 Fevereiro | 40 | 37 | 77 |
| 2023 Janeiro | 28 | 37 | 65 |
| 2022 Dezembro | 40 | 24 | 64 |
| 2022 Novembro | 58 | 55 | 113 |
| 2022 Outubro | 58 | 62 | 120 |
| 2022 Setembro | 33 | 59 | 92 |
| 2022 Agosto | 37 | 56 | 93 |
| 2022 Julho | 37 | 56 | 93 |
| 2022 Junho | 39 | 63 | 102 |
| 2022 Maio | 29 | 45 | 74 |
| 2022 Abril | 34 | 56 | 90 |
| 2022 Março | 41 | 58 | 99 |
| 2022 Fevereiro | 23 | 36 | 59 |
| 2022 Janeiro | 44 | 73 | 117 |
| 2021 Dezembro | 29 | 53 | 82 |
| 2021 Novembro | 41 | 74 | 115 |
| 2021 Outubro | 39 | 76 | 115 |
| 2021 Setembro | 30 | 54 | 84 |
| 2021 Agosto | 47 | 53 | 100 |
| 2021 Julho | 41 | 42 | 83 |
| 2021 Junho | 29 | 43 | 72 |
| 2021 Maio | 51 | 87 | 138 |
| 2021 Abril | 87 | 194 | 281 |
| 2021 Março | 48 | 53 | 101 |
| 2021 Fevereiro | 19 | 19 | 38 |
| 2021 Janeiro | 18 | 17 | 35 |
| 2020 Dezembro | 12 | 22 | 34 |
| 2020 Novembro | 11 | 8 | 19 |
| 2020 Outubro | 12 | 11 | 23 |
| 2020 Setembro | 10 | 13 | 23 |
| 2020 Agosto | 11 | 8 | 19 |
| 2020 Julho | 12 | 13 | 25 |
| 2020 Junho | 14 | 24 | 38 |
| 2020 Maio | 17 | 9 | 26 |
| 2020 Abril | 0 | 2 | 2 |
Mostrar tudo
