A fast-growing cold skin abscess revealing disseminated Mycobacterium intracellulare infection in an HIV-infected patient.
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Citations
Disseminated Mycobacterium intracellulare from a Deep Cutaneous Infection
References
Cutaneous non‐tuberculous mycobacterial infections
Cutaneous nontuberculous mycobacterial infection: a clinicopathological study of 7 cases.
Infection with Mycobacterium avium—intracellulare with abscess, ulceration and fistula formation
Pulmonary Disease Due To Non-Tuberculous Mycobacteria
Atypical mycobacterial cutaneous infections in Egyptians: a clinicopathological study.
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Frequently Asked Questions (11)
Q2. What is the predominant pathway to disease?
The MAC complex agents are ubiquitous slowgrowing pathogens and environmental exposure is considered the predominant pathway to disease.
Q3. What is the common cause of disseminated AM?
1Disseminated AM disease in HIV patients is due to MAC in >90% of cases, with more than 90% of those infections due to M. avium; it tends to occur in patients who are severely immunocompromised, as evidenced by very low CD4þ T-cell counts.
Q4. How many cases of MAC have been reported?
Regardingcutaneous AM disease occurring globally, several recent case series classify 65–86% of the affected patients as immunocompetent.
Q5. What is the role of the dermatologist in the care of patients with MAC?
As a crucial part of multidisciplinary teams, the dermatologist is on the front line of care for severely immunocompromised patients and a high level of suspicion is mandatory when approaching these cases.
Q6. What was the name of the patient?
The patient was kept on TDF/FTCþRAL in addition to clarithromycin 250mg bid, ethambutol 1200mg qd and rifabutin 300mg qd for 24 months.
Q7. How long did the MAC treatment last?
After 24 months of therapy, the immune status had improved (CD4þ cell count of 261 cells/mm3, viral load <20copies/mL) and the antimycobacterial therapy was stopped.
Q8. What was the name of the abscess?
This skin abscess was surgically drained, releasing an abundant odorless yellowish thick fluid that was fully aspirated and sent for culture – aerobic and anaerobic bacteria, fungi and mycobacteria.
Q9. What are the common agents in cutaneous AM?
As most cases of cutaneous AM infection occur in immunocompetent patients and are limited to skin and soft tissues, other agents as Mycobacterium marinum or Mycobacterium fortuitum are much more commonly reported.
Q10. What is the common type of MAC disease?
2–4 MAC disease, on the other hand, is much more common in immunosup-pressed individuals, mainly in persons with advanced HIV infection, and the more frequent clinical presentation is lung disease or disseminated disease.
Q11. What was the cause of the abscess?
One month after the first surgical drainage, Mycobacterium intracellulare was identified as the causative agent of the skin abscess (culture and nuclear hybridization).