Sporotrichoid Mycobacterium marinum infection of the face following a cat scratch.
Mycobacterium marinum infections in humans uncommonly affect the face and are not known to be associated with cat scratches. We describe a 24-year-old woman who presented with a 3-month history of multiple tender, occasionally discharging cystic nodules involving the left side of her face in a sporotrichoid distribution. She had suffered a cat scratch to her left lower eyelid 3 weeks before the onset of the eruption and owned multiple tropical fish tanks. She was systemically well and had no lymphadenopathy. She had a background history of a 4.5-mm-thick nodular melanoma of her temple treated by wide local excision and negative sentinel lymph node biopsy 4 years prior. Skin biopsies showed multiple variably sized granulomas surrounded by thick cuffs of lymphocytes involving the superficial and deep dermis with no organisms seen on Ziehl-Neelsen, peroidic acid-Schiff and methenamine silver stains. Laboratory investigations showed a mildly raised erythrocyte sedimentation rate but normal full blood count and C-reactive protein. Fluid from the left cheek grew an acid-fast bacillus identified as Mycobacterium marinum. The skin eruption cleared after 5-month treatment with oral clarithromycin 500 mg twice daily and rifampicin 600 mg daily.
Department of Dermatology, Royal Newcastle Centre, New Lambton, New South Wales 2303, Australia.
Tai Anh
TA
Phan
John
J
Relic
D000818:Animals; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D002415:Cats; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005145:Face; D005260:Female; D006801:Humans; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D019910:Mycobacterium marinum / Q000302:isolation & purification*; D012293:Rifampin / Q000627:therapeutic use; D014382:Tuberculosis, Cutaneous / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D055815:Young Adult
D000904:Antibiotics, Antitubercular; D002097:C-Reactive Protein; D017291:Clarithromycin; D012293:Rifampin