Cutaneous infection caused by Mycobacterium avium after an aesthetic abdominoplasty: Case report
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CASE REPORT
Cutaneous infection caused by Mycobacterium avium after an aesthetic abdominoplasty: Case report Infecção cutânea por Mycobacterium avium pós-abdominoplastia estética: Relato de caso Aline Rodrigues1, Luís Fernando Perin2, Américo Helene Junior3
ABSTRACT The present study reports an extremely rare complication following a cosmetic abdominoplasty. A skin infection caused by Mycobacterium avium was manifested as multiple skin nodules in the abdominal flap that were clinically and surgically treated. The authors report the case and its clinical course, and present a correlation with the literature. Keywords: Mycobacterium avium/pathogenicity; Mycobacterium avium/growth & development; Mycobacterium avium/isolation & purification; Mycobacterium avium/drug effects; Mycobacterium infections; Abdomen/surgery; Plastic surgery
RESUMO O presente estudo relata uma complicação extremamente rara como provável evolução pós-operatória de uma abdominoplastia estética. Uma infecção cutânea causada pelo agente Mycobacterium avium, com formação de múltiplos nódulos no retalho abdominal, tratada clínica e cirurgicamente. Os autores relatam o caso e sua evolução, correlacionando com dados da literatura. Descritores: Mycobacterium avium/patogenicidade; Mycobacterium avium/crescimento & desenvolvimento; Mycobacterium avium/isolamento & purificação; Mycobacterium avium/efeito de drogas; Micobacteriose; Abdome/cirurgia; Cirurgia plástica
INTRODUCTION Mycobacterium avium is a common pathogen in the environment, and it can be found in water, soil and house dust. This atypical mycobacterium has low pathogenicity in healthy individuals(1). The systemic infection caused by these bacteria is well documented,
especially in immunodeficient hosts(2). The systemic disease presents as lung, liver and lymph nodes involvement; however, the skin involvement caused by blood dissemination is rare(3). In the present study, we report a case of skin infection caused by Mycobaterium avium, without other systemic involvement, in a previously healthy patient who underwent a cosmetic abdominoplasty associated with a silicone breast implant.
CASE REPORT A female patient, 30 years old, complained of multiple skin nodules in her abdomen, three months after classic abdominoplasty and silicone implant performed in another hospital. The patient denied previous diseases, treatment with immunosuppressive drugs or any kind of aesthetic treatment such as mesotherapy. Physical examination showed nodular lesions in the abdominal wall, with signs of hyperemia and fluctuation, and no lesion in her breasts (figure 1). Abdominal assessment with computerized tomography identified images of skin disruption and obliteration of the subcutaneous tissue by a dense material and the presence of a small gas collection (figure 2). Skin lesion biopsy showed dermal lymphocytic and histiocytic infiltrates, multinucleated giant cells, and vascular neoformation. Ziehl-Neilsen test for acid-fast bacillus was negative. Tissue culture in solid medium (Louvestein-Jarsen) and in fluid medium (Automated System MB-BACT Continuous Monitoring) showed colony growth after eight weeks, and Mycobacterium avium was identified
1
Resident of the Discipline of Plastic Surgery, Department of Surgery - Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil.
2
Graduate student of the Discipline of Plastic Surgery - Santa Casa de Misericórdia de São Paulo – São Paulo (SP), Brazil.
3
MSc in Plastic Surgery from Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil. Corresponding author: Aline Rodrigues - Rua Cesário Motta Júnior, 112 - Vila Buarque - CEP 012010-020 - São Paulo (SP), Brazil - e-mail: cirurgia.plá
[email protected] Received on Jan 25, 2004 – Accepted on Jun 20, 2004
einstein. 2005; 3(1):27-28
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Rodrigues A, Perin LF, Junior AH
Figure 1. Acute lesions. Figure 3. Current picture with scarring lesions.
Figure 2. CT aspect of the abdomen with acute lesions.
by molecular biology technique. Antibiogram was sensitive to clarithromycin and triple drug regimen to treat tuberculosis. The triple drug regimen was initially used considering that the likely etiology was Mycobacterium tuberculosis. It was also complemented with ethambutol because of skin lesions and possible association of other groups of Mycobacterium. After the diagnosis of Mycobacterium avium was confirmed, clarithromycin was added to the drug regimen. Complete surgical resection of the nodules was performed, followed by topical application of rifamycin. The patient is currently on the ninth month of treatment and presents scarring areas in the abdomen (figure 3).
DISCUSSION Most infections caused by Mycobacterium avium present as lung disease, although lymphadenitis, osteomyelitis, skin infections and generalized infections can also occur(4-5). Skin manifestation is extremely rare and it can happen in three situations(6-7): traumatic inoculation of the skin, contiguous spread in patients with cervical lymphadenitis, and in generalized infection by means of blood dissemination(8). einstein. 2005; 3(1):27-28
For being a healthy patient with no previous disease or treatment with immunosuppressive drugs, and also the fact of having received the silicone breast implant, with no clinical manifestations in her breasts, we believe that the skin infection may be associated with the surgical procedure by means of traumatic inoculation. Skin infection caused by Mycobacterium avium is not common, and this kind of complication is even rarer in previously healthy patients undergoing cosmetic treatment. Considering that the main purpose of a cosmetic surgery is the achievement of better body contour, we concluded that this kind of complication may significantly compromise the aimed result and cause frustration to both physician and patient.
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