Byline: S. Sarma, R. Thakur
Cutaneous infection with rapidly growing mycobacteria is uncommon and its diagnosis can be missed unless there is strong clinical suspicion coupled with microbiological confirmation. We report a case of localized recurrent soft tissue swelling of the foot by Mycobacterium fortuitum in a healthy adult male. The case is being reported for its uncommon clinical presentation and the associated etiological agent. The patient recovered completely following therapy with amikacin and clarithromycin.
Skin and soft tissue infections caused by rapidly-growing mycobacteria, which used to be considered unusual, have become more frequent in the recent time. Among the rapidly growing non tuberculous mycobacteria (NTM), Mycobacterium fortuitum and Mycobacterium chelonae have been reported to cause a variety of manifestations ranging from skin and wound infections to disseminated infections like septicaemia, meningitis and endocarditis.[sup]  These NTM organisms are probably transmitted by aerosol, soil, dust, water, ingestion or by skin inoculation, whereas its person to person spread is rare.[sup]  Infection by these organisms leads to delayed wound healing and requires prolonged course of expensive antibiotics thereby increasing the morbidity of patients. The chance of overlooking these organisms is high unless microbiological confirmation is done. We report an unusual presentation of soft tissue swelling caused by Mycobacterium fortuitum in a healthy immunocompetent individual.
A 62-year-old healthy male belonging to the upper middle class presented in November 2007 with a history of swelling (5x6cm) on the lateral aspect of his left foot near the base of the little toe. The swelling started about three months back, gradually increasing in size and was associated with moderate pain. It was insidious in onset without any preceding history of trauma or infection. The patient gave the history of a diagnostic aspiration from the swelling done about 20 days back, following which the swelling had subsided. The cytological findings of the aspirate were inconclusive and the swelling recurred within the next few days in spite of a seven days course of ciprofloxacin (500mg, PO, BD) which brought the patient back for a repeat evaluation. On examination, the swelling was tense, cystic, tender and was fixed to the underlying structures. There was no local rise of temperature. Systemic examination...