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alliedacademies
Archives of General Internal Medicine | Volume 2
&
April 04-05, 2018 | Miami, USA
International Conference on
Internal Medicine & Practice and Primary Care
International Meeting on
Breast Pathology & Cancer Diagnosis
There have been reports associated with an increased
number of Mycobacterium species and nontuberculous
species isolated from those who received plastic surgery
procedures in the Dominican Republic. Mycobacterium
abscesses is associated with nosocomial transmissions and is
responsible for multiple soft tissue diseases, bacteremia and
is known to be quite multi-drug resistant. We have a case
of suspected Mycobacterium abscesses in a patient who
had liposuction and an abdominoplasty in the Dominican
Republic and later on developed multiple abscesses at the
liposuction injection sites.
Case Presentation: Our patient is a 53 year-old Trinidadian
female withou t significant PMHx who completed liposuction
along with abdominoplasty involving a redistribution of the
fat into the buttocks in the Dominican Republic. Patient
reports that one month after the procedure, she started to
experience pain in her buttocks associated with fevers and
chills. Shehadan incision anddrainage at amajor NYChospital
and cultures were taken at that time. Patient remained in
the hospital for IV Imipenem/Cilastatin and Cefoxitin. AFB
stain from the first I+D was positive for Mycobacterium sp.
She continued to have persistent pain even while on her
antibiotic regimen at home, therefore, she presented to
our hospital a few weeks after her previous discharge. On
physical exam, there were multiple abscess formations of
varying sizes (1cm to 8cm) at the liposuction sites that were
variably fluctuant in nature. Mycobacterium abscesses was
not isolated in our hospital, but clinical suspicion was very
high due to travel history and positive AFB from prior wound
culture; hence, the patient was discharged on Ciprofloxacin,
Clarithromycin and Linezolid for 4 months with a follow up at
our Infectious Disease office.
Discussion: Mycobacterium abscesses is comprised of a
group of multi drug resistant subclasses of nontuberculous
mycobacteria that are responsible for pulmonary, CNS,
ocular, skin and deep tissue manifestations in addition to
bacteremia. It was known to be a water contaminant but
over the years it has been known to contaminate medical
devices. AFB stain for Mycobacterium sp has a specificity
of 97.5%. However, in our patient, wound cultures did not
show any microbial growth which is most likely due to the
patient being on multiple antibiotic treatments. Typical
treatment is a combination antimicrobial therapy of a
macrolide usually Clarithromycin in addition to Amikacin
and Cefoxitin or Amikacin and Imipenem for several months.
Source of infection could be contaminated tap water used to
clean the cannulae during liposuction or contamination of
the ammonium solution used to disinfect the instruments.
Speaker Biography
Marissa Sansone, MD Internal Medicine Resident at Jersey City Medical Center -
Barnabas Health Jersey City Medical Center - Barnabas Health St. George’s University
Lyndhurst, New Jersey.
e:
Suspected Mycobacterium abscesses infection post cosmetic surgery in the Dominican Republic
Marissa Sansone
Jersey City Medical Center, USA