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Title : A 34 year-old female w/ left mastitis
Date : April 1, 2010
Contributed by

Hyun-Ha Chang, M.D.
Kyungpook National University Hospital

Patient History
Age/Sex 34-yr old / Female
Chief complaint 34-year old woman with left mastitis
Present illness

Four months before visiting a hospital, she got a brest augmentation surgery. After 2 months, she presented painful swelling and multiple erythematous nodules on left breast. The attending surgeon removed breast augmentation material and started intravenous antibiotic therapy, but her symptoms were not resolved.

Past medical history

none

Physical examination
Initial laboratory findings

CBC 6,500(seg 52.3%)- 13.3 g/dL -450,000/mm3 ESR 55mm/Hr CRP 1.5 mg/dL, AST/ALT 24/19 U/L BUN/Cr 15.0/0.7 mg/dL

Radiologic findings

 
Question - ID Case of the Week ( April 1, 2010 )
What is your diagnosis?
 
Correct Answer

Postoperative mastitis by Mycobaterium abscessus

 
Review

Soft tissue infections due to rapidly growing mycobacteria (RGM) are often associated with treatment in health care facilities, both inpatient and outpatient(Clin Infect Dis. 2001 Oct 15;33(8):1363-74). Postoperative infections with RGM have occurred following augmentation mammoplasty, cosmetic surgery procedures, laser in situ keratomileusis (LASIK), and heart surgery, most often in the southeastern and southern coastal United States or in more tropical countries such as Brazil(Br J Plast Surg 2004 Oct;57(7):676-8). Nonsterile water (or ice made from nonsterile water) is a frequent source of RGM in nosocomial infections. Avoidance of nonsterile tap water is the single most important factor for preventing nosocomial RGM infections.

Infection is characterized by multiple recurrent abscesses around the surgical wound. Identification of the etiologic mycobacterium is often delayed because only routine cultures are obtained and the culture plates are discarded by the laboratory after failing to grow in a few days.

Illustrative cases include:
* Illicit soft-tissue augmentation in New York City resulted in an outbreak of M. abscessus infection in 2002, due to contamination of the hyaluronic acid derivative used in the procedure(Dermatol Surg 2003 Sep;29(9):971-3).
* Mycobacterium abscessus was responsible for an outbreak of wound infections among 20 Dominican Republic "lipotourists" due to this pathogen highlighted the risks of infection associated with surgical procedures performed in settings with inadequate infection control practices (Clin Infect Dis. 2008 Apr 15;46(8):1181-8).

 


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