Acta Dermato-Venereologica 98-10CompleteContent | Page 20
987
A Case of Subcutaneous Infection with Mycobacterium mageritense Identified by Matrix-assisted
Laser Desorption/Ionization-time of Flight Mass Spectrometry
Tomohiro OIWA 1 , Teruasa MURATA 1 , Tetsuya HONDA 1 , Satoshi NAKANO 2 and Kenji KABASHIMA 1 *
Department of Dermatology, and 2 Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-
Kawahara, Sakyo, Kyoto 606-8507, Japan. *E-mail: [email protected]
1
Accepted Jul 5, 2018; Epub ahead of print Jul 6, 2018
Mycobacterium mageritense is a recently identified
rapidly growing uncommon mycobacteria (RGM) (1).
Only 9 cases of skin and soft-tissue infection with M.
mageritense have been reported to date (1–7) (Table
I). Although accurate identification of the pathogenic
bacteria is mandatory for efficient treatment, using
conventional methods for the identification of M. mage-
ritense is complex and time-consuming. We report here
a case of subcutaneous infection with M. mageritense
that was treated successfully with antibiotics, in which
matrix-assisted laser desorption/ionization-time of flight
mass spectrometry (MALDI-TOF MS) (8) enabled rapid
identification of the species.
CASE REPORT
A 70-year-old Japanese man developed subcutaneous abscesses
in the periumbilical region within 2 weeks after a laparoscopic
cholecystectomy. After unsuccessful treatments with antibiotics
(cefamezin and vancomycin) and immunosuppressive agents
Table I. Summary of 9 cases of skin and soft tissue infection with
M. mageritense reported
Surgical
Sex/age, inter
years
vention Antibiotics Duration of
treatment Outcomes Ref.
F/37
M/25
F/43
F/56
M/48
F/59
M/66
M/52
F/85
M/70 DOXY, CFPM
AMK, IPM/CS
TMP-SMX, LVFX
GFLX
N/A
CPFX, CAM
MLFX, CAM
CAM, LVFX
LVFX, IPM/CS, MINO
CAM, LVFX, MINO 9 months
N/A
3 months
2 months
12 months
12 months
4 days
6 months
4 months
7 months
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
No
Cured
Improved
Cured
Cured
Cured
Cured
Cured
Cured
Cured
Cured
1
1
2
2
3
4
5
6
7
This case
DOXY: doxycycline; CFPM: cefepime; AMK: amikacin; IPM/CS: imipenem/cilastatin;
TMP-SMX: trimethoprim/sulfamethoxazole; LVFX: levofloxacin; GFLX: gatifloxacin;
CPFX: ciprofloxacin; MLFX: moxifloxacin; CAM: clarithromycin; IPM/CS: imipenem/
cilastatin; MINO: minocycline; N/A: not available; F: female; M: male.
(prednisolone and azathioprine) for 1 year, he was referred to our
hospital. On examination, a total of 80 reddish nodules intermit-
tently excreting pus were observed on the abdomen (Fig. 1a).
Histopathologically, the dermis and subcutaneous adipose tissue
were prominently infiltrated with neutrophils (Fig. 1b, c). An
SHORT COMMUNICATION
Fig. 1. Clinical pictures and histopathology.
(a) A clinical picture before the treatment, showing
reddish nodules on the abdomen. Arrow: scar from
the laparoscopic cholecystectomy contiguous to the
umbilicus. Histopathology: (b) low-magnification
view showing a prominent infiltration of neutrophils
in the deep dermis and subcutaneous adipose tissue.
(c) High-magnification view of the rectangle in (b).
(d) A clinical picture after treatment with antibiotics,
showing post-inflammatory pigmentation.
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2018 Acta Dermato-Venereologica.
doi: 10.2340/00015555-3005
Acta Derm Venereol 2018; 98: 987–988