Abstract
Disease due to Mycobacterium marinum has been well characterized as to epidemiology, pathogenesis, potential clinical courses, diagnostic methods, and effective forms of therapy. 1-8 The article by Donta et al 9 in a previous issue of the Archives raised several points that need be addressed. Although M marinum usually causes a localized cutaneous lesion that may be nodular, verrucous, or ulcerative, it may progress in a sporotrichoid fashion or, rarely, involve deeper structures. Unfortunately, diagnosis is frequently delayed, with M marinum being considered only after the patient fails to respond to multiple empiric antibiotic regimens (patients 1, 2, and 3) and not infrequently to the addition of potassium iodide (SSKI [Upsher-Smith]) (patients 1 and 4). This all-too-common antimicrobial cascade is particularly distressing, because an adequate history of the present illness and review of occupational and recreational activities usually yield strong diagnostic clues (eg, swimming pool or seawall abrasions, barnacle scrapes,
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