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July 2007

Dissemination of a Localized Cutaneous Infection With Mycobacterium chelonae Under Immunosuppressive Treatment

Arch Dermatol. 2007;143(7):945-955. doi:10.1001/archderm.143.7.951

We report a case of an initially localized cutaneous infection with Mycobacterium chelonae on the left breast. Owing to the failure to recognize the causative agent, high-dose immunosuppressive treatment was administered for 2 years. As a result, infection disseminated with the development of multiple ulcerating and fistulating nodules on the right leg.

A 60-year-old woman presented to a local district hospital in December 2001 with a 1-year history of an ulcerating abscess on her left breast, which had appeared after a blunt trauma. Between 2001 and 2003, repeated aspirates from the abscess were found to be sterile. Histopathologic examinations revealed poorly formed granuloma with chronic inflammation and suppuration in the dermis and subcutis. Ziehl-Neelsen staining was not performed. Short-term antibiotic treatments (with clindamycin, vancomycin, ciprofloxacin, and cotrimoxazole) and repeated extensive surgical debridements performed between 2001 and 2003 proved ineffective.

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