2018 Volume 80 Issue 6 Pages 539-545
A 68-year old woman suffering from chronic renal failure and liver eirrhosis had noted multiple subcutaneous abscesses on the backs of both hands and her right foot since March. The abscesses had initially been treated in another division; however, as they did not improve, she was transferred to our division in July. Deep mycosis or a nontuberculous mycobacterial infection was suspected based on the results of a histological examination. Because the β-D glucan level was high and fungi were detected in the abscess, the patient was diagnosed to have multiple subcutaneous abscesses due to deep mycosis and treated with antifungal medicines. Thereafter, the β-D glucan level normalized; however, her rashes gradually worsened. Bacterial cultures were repeated, and culture of the pus taken from an abscess on the hand finally revealed Mycobacterium chelonae (M. chelonae) on culture plates for usual bacteria as well as on a Sabouraud glucose agar plate. Based on the clinical course and these findings, the patient was ultimately diagnosed to have nontuberculous mycobacterial infection due to M. chelonae in association with deep mycosis and treated with additional clarithromycin and clindamycin. Although the rashes had nearly disappeared by early November, the patient died several days after. Given her high blood β-D glucan levels, the patient had been treated for multiple subcutaneous abscesses due to deep mycosis, but the rashes showed no improvement. The causative bacteria had not been identified despite repeated bacterial cultures, but the present case was ultimately diagnosed as multiple subcutaneous abscesses due to M. chelonae infection, as the bacteria grew on plates meant for non-mycobacteria. The present course underscores the importance of repeating bacterial cultures when encountering non-healing multiple subcutaneous abscesses in potentially immunosuppressed patients, while always bearing in mind the possibility of a non-tuberculous mycobacterial infection.
