Images in Clinical Medicine

Piercing-Related Nontuberculous Mycobacterial Infection

Kimberly A. Horii, M.D., and Mary Anne Jackson, M.D.

N Engl J Med 2010; 362:2012May 27, 2010

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Article

An 18-year-old woman with the long-QT syndrome was referred to our dermatology clinic with a large, fluctuant, violaceous plaque on her right cheek (Panel A). Her right tragus had been professionally pierced 6 months earlier, and streaking had developed along the angle of her jaw 1 month after the piercing. Her primary care physician drained an abscess in the region and prescribed cephalexin, but the condition did not improve. On further evaluation, an atypical infectious cause was considered, and a biopsy was performed; the specimen showed granulomatous inflammation but no acid-fast bacilli. The tissue culture grew Mycobacterium fortuitum. Four months of treatment with ciprofloxacin and trimethoprim–sulfamethoxazole resulted in clinical improvement at follow-up (Panel B). A macrolide was not administered, owing to the use of a beta-blocker. Various cutaneous presentations, including pustules, plaques, and ulcers, can be due to infection with nontuberculous mycobacterium. This should be considered when piercing-related infections fail to respond to antibiotics that are effective against common bacterial pathogens. Acid-fast bacilli are not always detectable on staining; definitive diagnosis depends on isolation of the organism on tissue culture.

Kimberly A. Horii, M.D.
Mary Anne Jackson, M.D.
Children's Mercy Hospitals and Clinics, Kansas City, MO
kahorii@cmh.edu

Citing Articles (3)

Citing Articles

1. 1

   Jaimee Holbrook, Julia Minocha, Anne Laumann. (2012) Body Piercing. American Journal of Clinical Dermatology 13:1, 1-17
   CrossRef

2. 2

   Pietro Nenoff, Georgi Tchernev, Uwe Paasch, Werner Handrick. (2011) Haut- und Weichgewebe-Infektionen durch nicht-tuberkulöse Mykobakterien: Ätiologie, Epidemiologie, Pathogenese, Klinik, Diagnostik, differenzialdiagnostische Aspekte und Empfehlungen für die Therapie. Wiener Medizinische Wochenschrift 161:17-18, 426-432
   CrossRef

3. 3

   (2011) Piercing et infection à mycobactérie non tuberculeuse. Revue Francophone des Laboratoires 2011:429, 29
   CrossRef