전이성 유방암 환자에서 발생한 Mycobacterium abscessus에 의한 파종성 피부 및 연부조직 감염 1예
A Case of Disseminated Skin and Soft Tissue Infection due to Mycobacterium abscessus with Metastatic Breast Cancer
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Mycobacterium abscessus is a rapidly growing species of environmental mycobacteria commonly found in soil, dust, and water throughout the world. In immunocompetent patients, M. abscessus usually causes localized infection of skin and soft tissue in association with a traumatic or surgical wound. Although rare, it may cause disseminated systemic infection in patients with HIV, diabetes, or medically induced immunosuppression. Here we report a case of a 53-year-old female patient with disseminated skin and soft tissue infection due to M. abscessus who presented with multiple skin lesions on the trunk, back and four extremities. The patient had undergone salvage chemotherapy, modified radical mastectomy, and palliative chemotherapy for metastatic breast cancer. Granulomatous inflammation and acid-fast bacilli were found on skin biopsy. M. abscessus was identified via mycobacterial culture and PCR-restriction fragment length polymorphism analysis. The patient responded well to clarithromycin, cefoxitin and amikacin therapy,and was subsequently discharged on oral antimicrobial therapy. Non-tuberculous mycobacterial (NTM) infection is a rare cause of skin and soft tissue infection, and a very high index of suspicion is required to initiate an evaluation for NTM. In metastatic cancer patients with multiple skin lesions, skin infection due to NTM must be differentiated not only from cutaneous metastasis but also from bacterial or fungal infection.
Abstract
Mycobacterium abscessus is a rapidly growing species of environmental mycobacteria commonly found in soil, dust, and water throughout the world. In immunocompetent patients, M. abscessus usually causes localized infection of skin and soft tissue in association with a traumatic or surgical wound. Although rare, it may cause disseminated systemic infection in patients with HIV, diabetes, or medically induced immunosuppression. Here we report a case of a 53-year-old female patient with disseminated skin and soft tissue infection due to M. abscessus who presented with multiple skin lesions on the trunk, back and four extremities. The patient had undergone salvage chemotherapy, modified radical mastectomy, and palliative chemotherapy for metastatic breast cancer. Granulomatous inflammation and acid-fast bacilli were found on skin biopsy. M. abscessus was identified via mycobacterial culture and PCR-restriction fragment length polymorphism analysis. The patient responded well to clarithromycin, cefoxitin and amikacin therapy,and was subsequently discharged on oral antimicrobial therapy. Non-tuberculous mycobacterial (NTM) infection is a rare cause of skin and soft tissue infection, and a very high index of suspicion is required to initiate an evaluation for NTM. In metastatic cancer patients with multiple skin lesions, skin infection due to NTM must be differentiated not only from cutaneous metastasis but also from bacterial or fungal infection.
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