title: An outbreak of Mycobacterium chelonae infections in tattoos.
abstract: Nontuberculous mycobacteria infections may occur after cutaneous procedures. Review of the medical records of patients who developed a rash within a tattoo revealed 6 patients with skin infections caused by Mycobacterium chelonae after receiving tattoos by one artist at a single tattoo establishment. The interval between tattoo placement and the skin findings was 1 to 2 weeks. All patients received alternate diagnoses before mycobacterial infection was identified. Skin findings included pink, red, or purple papules; papules with scale; pustules; granulomatous papules; and lichenoid papules and plaques. Histopathologic examination revealed granuloma, lymphohistiocytic infiltrate, or mixed inflammation; acid-fast bacilli stains produced negative results. Diagnosis was made by culture in 3 patients, histopathology in two patients, and clinical/epidemiologic association in one patient. The M chelonae isolates were clarithromycin susceptible, and the infections responded to macrolide antibiotics. Physicians should consider mycobacterial infections in patients with skin findings within a new tattoo.
authors.affiliation: Division of Clinical Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. drage.lisa@mayo.edu
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Drage
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Ecker
authors.forename: Robert
authors.initials: R
authors.lastname: Orenstein
authors.forename: P Kim
authors.initials: PK
authors.lastname: Phillips
authors.forename: Randall S
authors.initials: RS
authors.lastname: Edson
mesh_terms: D000328:Adult; D017291:Clarithromycin / Q000627:therapeutic use; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D016926:Mycobacterium chelonae / Q000302:isolation & purification; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D013653:Tattooing / Q000009:adverse effects*
chemical_list: D017291:Clarithromycin