Subacute Multifocal Abscesses Related to a Mycobacterium marinum Infection in a Child

Abstract

An 8-year-old boy presented with multiple inflammatory cutaneous lesions on both hands that had been evolving for 4 weeks. At the onset, the child received a 10-day course of amoxicillin/clavulanic acid without improvement. Findings of a physical examination revealed multiple abscesses on both hands (Figure 1) and a suppurative adenopathy of the right arm (Figure 2). The child had no history of fever and was in good health. He had no other symptoms or clinical signs. There were no laboratory abnormalities detected. Conventional bacteriological examination of a hand skin biopsy revealed Staphylococcus epidermidis contamination; mycological culture, Orthopoxvirus, and Parapoxvirus polymerase chain reaction were negative. Inflammatory changes without granuloma were noticed on histologic analysis. An aspirate was collected from the lymph node; after 6 weeks of prolongated culture at 30°C, the laboratory isolated Mycobacterium marinum on Coletsos solid medium. The child then reported having played in a pond a few weeks before the abscesses. A 1-month course of clarithromycin accelerated the healing process.Figure 2Inflammatory adenopathy of the arm.View Large Image Figure ViewerDownload Hi-res image Download (PPT) M marinum is the most frequent nontuberculous mycobacteria (NTM) involved in skin infection. This cosmopolitan infection occurs in a patient with a history of minor trauma exposed to soil or more often water containing contaminated fish. It typically affects the exposed areas of the upper limbs and presents as a single nodule that occasionally spreads in a sporotrichoid disposition. Abscessed forms of NTM skin infection usually are associated with rapidly growing NTM and rarely with M marinum.1Cantisani C. Richetta A. Bitonti A. Curatolo P. Ferretti G. Mattozzi C. et al.Recurrent cutaneous abscesses in two Italian family members.Infect Dis Rep. 2010; 2: 11Crossref Scopus (2) Google Scholar, 2Feng H. Su Y. Fu S. Zhou Y. Xiao R. Wu R. et al.Image gallery: fish tank granuloma on the face with sporotrichoid cervicofacial lymphadenitis and abscesses due to Mycobacterium marinum infection.Br J Dermatol. 2019; 180: e180Crossref PubMed Scopus (1) Google Scholar, 3Mei Y. Zhang W. Shi Y. Jiang H. Chen Z. Chokkakula S. et al.Cutaneous tuberculosis and nontuberculous mycobacterial infections at a national specialized hospital in China.Acta Derm Venereol. 2019; 99: 997-1003Crossref PubMed Scopus (7) Google Scholar Systemic dissemination of the infection can occur in immunocompromised subjects.4Enzensberger R. Hunfeld K.-P. Elshorst-Schmidt T. Böer A. Brade V. Disseminated cutaneous Mycobacterium marinum infection in a patient with non-Hodgkin’s lymphoma.Infection. 2002; 30: 393-395Crossref PubMed Scopus (22) Google Scholar Diagnosis is confirmed in about 75% of cases by solid culture, which may take several weeks. The laboratory should be made aware of the suspicion of M marinum infection to perform specific cultures. DNA-specific polymerase chain reaction amplification on skin biopsy may confirm the diagnosis in case of culture negativity.5Bonamonte D. De Vito D. Vestita M. Delvecchio S. Ranieri L.D. Santantonio M. et al.Aquarium-borne Mycobacterium marinum skin infection. Report of 15 cases and review of the literature.Eur J Dermatol. 2013; 23: 510-516Crossref PubMed Scopus (29) Google Scholar Histology frequently reveals a granulomatous reaction, but a nonspecific inflammatory infiltrate without granulomatous reaction can be observed.5Bonamonte D. De Vito D. Vestita M. Delvecchio S. Ranieri L.D. Santantonio M. et al.Aquarium-borne Mycobacterium marinum skin infection. Report of 15 cases and review of the literature.Eur J Dermatol. 2013; 23: 510-516Crossref PubMed Scopus (29) Google Scholar