Background. Dermal piercings have recently become a fashion symbol. Common complications include hypertrophic scarring, rejection, local infection, contact allergy, and traumatic tearing. We report a rare case of Mycobacterium fortuitum following a dermal piercing and discuss its medical implications and treatments. Case. A previously healthy 19-year-old woman presented complaining of erythema and edema at the site of a dermal piercing on the right fourth dorsal finger. She was treated with a 10-day course of trimethoprim-sulfamethoxazole and one course of cephalexin by her primary care physician with incomplete resolution. The patient stated that she had been swimming at a local water park daily. A punch biopsy around the dermal stud was performed, and cultures with sensitivities revealed Mycobacterium fortuitum. The patient was treated with clarithromycin and ciprofloxacin for two months receiving full resolution. Discussion. Mycobacterium fortuitum is an infrequent human pathogen. This organism is a Runyon group IV, rapidly growing nontuberculous mycobacteria, often found in water, soil, and dust. Treatment options vary due to the size of the lesion. Small lesions are typically excised, while larger lesions require treatment for 2–6 months with antibiotics. We recommend a high level of suspicion for atypical mycobacterial infections in a piercing resistant to other therapies. 1. Introduction Mycobacterium fortuitum is a Runyon group IV, rapidly growing nontuberculous mycobacteria, often found in water (even municipal water systems), soil, and dust [1–5]. The portals of entry into humans include inhalation, mucosal, and via skin penetration [6]. Once it is has entered, it can cause respiratory infections, lymphadenitis, and skin/soft tissue infections, and in immunocompromised patients, it can lead to dissemination [5, 7]. Most common infections are cutaneous, usually associated with trauma or surgical procedures including liposuction, silicon injection, subcutaneous injections, acupuncture, and breast implants [3, 5, 7–10]. We report a case of M. fortuitum following a dermal piercing and discuss its medical implications and treatment. We also discuss other similar piercing infections caused by M. fortuitum and related mycobacteria. 2. Case Report A previously healthy 19-year-old Hispanic woman presented to our university-associated dermatology practice complaining of erythema, edema, and drainage at the site of a dermal piercing on the right fourth dorsal finger. The piercing was placed two months prior at a local piercing shop and became symptomatic
References
[1]
D. S. Behroozan, M. M. Christian, and R. L. Moy, “Mycobacterium fortuitum infection following neck liposuction: a case report,” Dermatologic Surgery, vol. 26, no. 6, pp. 588–590, 2000.
[2]
R. Fischeder, R. Schulze-R？bbecke, and A. Weber, “Occurrence of mycobacteria in drinking water samples,” Zentralblatt fur Hygiene und Umweltmedizin, vol. 192, no. 2, pp. 154–158, 1991.
[3]
J. Haiavy and H. Tobin, “Mycobacterium fortuitum infection in prosthetic breast implants,” Plastic and Reconstructive Surgery, vol. 109, no. 6, pp. 2124–2128, 2002.
[4]
K. L. Winthrop, M. Abrams, M. Yakrus et al., “An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon,” The New England Journal of Medicine, vol. 346, no. 18, pp. 1366–1371, 2002.
[5]
G. L. Woods and J. A. Washington II, “Mycobacteria other than Mycobacterium tuberculosis: review of microbiologic and clinical aspects,” Reviews of Infectious Diseases, vol. 9, no. 2, pp. 275–294, 1987.
[6]
P. Kullavanijaya, “Atypical mycobacterial cutaneous infection,” Clinics in Dermatology, vol. 17, no. 2, pp. 153–158, 1999.
[7]
A. Guevara-Patino, M. S. de Mora, A. Farreras, I. Rivera-Olivero, D. Fermin, and J. H. de Waard, “Soft tissue infection due to Mycobacterium fortuitum following acupuncture: a case report and review of the literature,” Journal of Infection in Developing Countries, vol. 4, no. 8, pp. 521–525, 2010.
[8]
D. R. G. Devi, V. A. Indumathi, S. Indira, P. R. S. Babu, D. Sridharan, and M. R. S. Belwadi, “Injection site abscess due to Mycobacterium fortuitum: a case report,” Indian Journal of Medical Microbiology, vol. 21, no. 2, pp. 133–134, 2003.
[9]
L. P. Fox, A. S. Geyer, S. Husain, P. Della-Latta, and M. E. Grossman, “Mycobacterium abscessus cellulitis and multifocal abscesses of the breasts in a transsexual from illicit intramammary injections of silicone,” Journal of the American Academy of Dermatology, vol. 50, no. 3, pp. 450–454, 2004.
[10]
R. J. Wallace Jr, J. M. Swenson, V. A. Silcox, R. C. Good, J. A. Tschen, and M. S. Stone, “Spectrum of disease due to rapidly growing mycobacteria,” Reviews of Infectious Diseases, vol. 5, no. 4, pp. 657–679, 1983.
[11]
T. Ferringer, H. Pride, and W. Tyler, “Body piercing complicated by atypical mycobacterial infections,” Pediatric Dermatology, vol. 25, no. 2, pp. 219–222, 2008.
[12]
C. G. Lewis, M. K. Wells, and W. C. Jennings, “Mycobacterium fortuitum breast infection following nipple-piercing, mimicking carcinoma,” Breast Journal, vol. 10, no. 4, pp. 363–365, 2004.
[13]
V. Bengualid, V. Singh, H. Singh, and J. Berger, “Mycobacterium Fortuitum and anaerobic breast abscess following nipple piercing: case presentation and review of the literature,” Journal of Adolescent Health, vol. 42, no. 5, pp. 530–532, 2008.
[14]
K. A. Horii and M. A. Jackson, “Images in clinical medicine. Piercing-related nontuberculous mycobacterial infection,” The New England Journal of Medicine, vol. 362, no. 21, article 2012, 2010.
