[Mycobacterium kansasii skin infection at insulin injection sites].
BACKGROUND
Insulin injection sites rarely become infected. We report a case of Mycobacterium kansasii infection at the sites of insulin injection.


METHODS
An 84-year-old woman with insulin-dependent diabetes consulted for lesions on the anterior aspect of the thighs. She had papulonodules at the sites of insulin injection. These lesions progressed to hard fibrinonecrotic ulcerations with a raised erythematous border. There were no enlarged nodes locally. Laboratory tests were normal. Bacteriological samples were negative at direct examination. Histology was not specific. The biopsy cultures finally found an atypical mycobacteria, Mycobacterium kansasii. The clinical course was favorable with clarithromycin alone.


CONCLUSIONS
Only 35 cases of Mycobacterium kansasii skin infections have been reported in the literature. This is the first case observed in a diabetic subject and the first treated with clarithromycin alone. This case illustrates the potential, though exceptional, risk of insulin bottle contamination by an environmental germ.
Domergue Thân Trong
E
E
Service de Dermatologie, Hôpital Bichat-Claude Bernard, 46, rue Henri Huchard, 75877 Paris Cedex 18.
Descamps
V
V
Larger
E
E
Grossin
M
M
Belaich
S
S
Crickx
B
B
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D007328:Insulin / Q000008:administration & dosage; D009165:Mycobacterium Infections, Nontuberculous / Q000209:etiology*; D019909:Mycobacterium kansasii; D017192:Skin Diseases, Bacterial / Q000209:etiology*
D007328:Insulin